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Hancock Metropolitan Housing Authority

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Housing Survey Form

Housing Survey Form

Applicant Name (*)	Invalid Input
Email (*)	Invalid Input

Please complete all of the information about the housing unit listed below.

Unit Information

Building Name	Invalid Input
Unit Street Address	Invalid Input
Unit Apartment Number	Invalid Input
Unit City	Invalid Input
Unit State	Invalid Input
Unit Zip	Invalid Input

Management and Owner Information

Managed By

OwnerManagement Company

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Management Information

Manager Name	Invalid Input
Manager Phone	Invalid Input

Is the Owner or Manager On Site

YesNo

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Owner Name	Invalid Input
Owner Adress	Invalid Input
Owner City	Invalid Input
Owner State	Invalid Input
Owner Zip	Invalid Input

Unit Size, Cost and Utlities Provided

Size of the Unit

Number of Bedrooms	Invalid Input
Number of Bathrooms	Invalid Input

Square Footage

Average
Above Average
Below Average

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Lease Information

Current Rent	Invalid Input
Date Rented	Invalid Input

Check all utilities that are included in the rent
Heat Water Heat Water Trash Collection Refrigerator Cooking Other Electric Sewer Air Conditioning Range Invalid Input

Types of Utilities Used

The Unit is heated with
Natural Gas Bottled Gas Oil Electric Coal Other Invalid Input

The hot water is heated with:
Natural Gas Bottled Gas Oil Electric Coal Other Invalid Input

The Stove Uses
Natural Gas Electric Bottled Gas Invalid Input

Unit Type, Quality and Age

Unit Type - Check box that best describes the unit.
Older Home Converted Older Multi-Family High Rise Two/Three Family / Duplex Mobile Home Single Family Detached Row House / Garden Apt. Invalid Input

Describe the overall quality and condition of the unit in comparison with other apartments you have seen.
Above Average Average Below Average Invalid Input

Estimated year of construction or last major renovation
Invalid Input

Check all the boxes that apply if the unit has specific features to assist people with the following types of disabilities.
Hearing Sight Mobility Other Invalid Input

Check all the boxes listed below that are included in the rent of the unit.
Balcony, patio, deck or porch Central Air Dishwasher Dryer Exceptional size relative to needs of family Garage Good maintenance of building exterior Good upkeep of grounds Large Yard Laundry Facilities Parking on site Playground Screen doors on windows Storage Unit Storm windows and doors Swimming Pool Washer Washer-Dryer Hookup Invalid Input

I certify that the information on this form is true and complete to the best of my knowledge and belief. I understand that I can be fined up to $10,000.00 if I furnish false or incomplete information.
I agree I do not agree Invalid Input

Enter the text you see to deliver this email.
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