Chemung County, NY · Chemung County
Landlord Statement
Chemung County landlords or their agents complete this statement to verify a tenant’s rental arrangement and provide housing details to the Department of Social Services.
At a glance
- Issued by
- City of Chemung County · Chemung County, Chemung County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- chemungcountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The Landlord Statement verifies a tenant’s address, rent, household members, and other housing details for the Chemung County Department of Social Services. The landlord or the landlord’s agent must complete the form and review it with the tenant; the form says it will not be accepted if completed by the tenant. It also includes an optional request for rent to be paid directly to the landlord from the tenant’s grant.
Who needs it
A landlord or the landlord’s agent completes this statement for a tenant whose rental arrangement is being verified by the Department of Social Services.
How to submit it
Submit it to the county office named on the form; check the county website for current contact details.
About notarization
This document is signed without a notary; the landlord or agent and tenant sign and date the form.
How to submit this form
- 1
Download the Form
Download the Landlord Statement PDF.
- 2
Complete the Form
The landlord or agent completes the form and reviews it with the tenant.
- 3
Gather Any Attachments
The document does not specify any attachments.
- 4
Submit to the County
Submit it to the county office named on the form; check the county website for current contact details.
Frequently asked questions
- Do I need a notary for the Landlord Statement?
- No. This document is signed without a notary; the landlord or agent and tenant sign and date the form.
- How do I submit the Landlord Statement?
- Submit it to the county office named on the form; check the county website for current contact details.
- Who must complete the Landlord Statement?
- The landlord or the landlord’s agent must complete the form and review it with the tenant. The form states it will not be accepted if completed by the tenant.
- What information does the Landlord Statement ask for?
- It asks for the rental address, rent and payment details, household members, included utilities or services, and landlord information. It also has an optional request for direct rent payment.