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A. Legal Owner Information: EIN - SSN 578-17-7124

The document contains instructions for property owners receiving rental assistance to complete owner and payee information. It includes sections for the legal owner name and contact details, payee information if different from owner, and an agent/manager section if one is designated. The owner and payee must sign certifying the information is correct and the payee will receive assistance payments and act on the owner's behalf if named. State financing program information and an agent authorization section are also included.

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Trevor Alexander
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119 views2 pages

A. Legal Owner Information: EIN - SSN 578-17-7124

The document contains instructions for property owners receiving rental assistance to complete owner and payee information. It includes sections for the legal owner name and contact details, payee information if different from owner, and an agent/manager section if one is designated. The owner and payee must sign certifying the information is correct and the payee will receive assistance payments and act on the owner's behalf if named. State financing program information and an agent authorization section are also included.

Uploaded by

Trevor Alexander
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Instructions: Each owner of a property receiving rental assistance must complete the Owner Information section below.

The owner will receive all


DHCD correspondence and Assisted Housing Relief Agreement unless a different agent/payee is designated below.

A. Legal Owner Information

Owner Name: ________Trevor Alexander___________________________________ Email: ______tealexander777@gmail.com______________


(as listed on the property grant deed)

Primary Phone Number: _____(202) 816-9456___________________ Alternate Phone Number: _____________________________________


Circle one: Home Work Cell Circle one: Home Work Cell

Owner Address:__6902 Highview Terrace #104___________________________ City _Hyattsville____ State _MD___ Zip Code __20782______

Enter Owner’s Employer Identification Number (EIN) issued by the Internal Revenue Service (IRS) or Social Security Number (SSN) in the below
box. The EIN/SSN must match the name given on the ‘Legal Owner Name’ line. The Maryland Department of Housing and Community
Development may request a copy of the EIN letter or Social Security card, if necessary.

EIN: - SSN: 578-17-7124


Is the legal owner of this property a trust or a trustee? □ YES □ NO
If YES, a copy of the executed trust document or other documentation confirming the person listed in Section A. is the trustee must be provided
to the Housing Authority with this form

B. Payee Information (Leave Blank if Owner is Also the Payee)


Payee Name: _____Hameed Hassan_____________________________________ Email: _hhassan@smcmail.com_____________________
(must match completed W-9 form)

Primary Phone Number: _____(301)559-8826_____________________ Alternate Phone Number: ___________________________________


Circle one: Home Work Cell Circle one: Home Work Cell

Payee Address:__7004 Hightview Terrace_______________________________ City ___Hyattsville___ State __MD__ Zip Code ___20782_____

If Payee will be receiving payment on Owner’s behalf, enter Payee Employer Identification Number (EIN) issued by the IRS in the below box. EIN
must match the name given on the “Payee Name” line. For individuals, enter the social security number (SSN). The Maryland Department of
Housing and Community Development may request a copy of the EIN letter or Social Security card, if necessary.

EIN: - SSN: - -

C. Agent or Manager Information

Is there a Manager or Agent for this property that is not the Owner or Payee that may act on the Owner’s behalf? □ YES □ NO
If Yes, please follow the instructions on the back of this form.

Owner and Agent Certification:


I certify that I am the legal owner for the unit referenced on this form and all the information on this form is true and correct. I understand
that if I name a Payee other than myself, the Payee will receive in their name all Assistance Payments and owner correspondence and will
act on my behalf regarding all housing matters for the rental property. If Payee is a real estate agent, the agent must use Form 1099-MISC
to report the rent paid to the property owner per IRS regulation section 1.6041-1(e)(5)]. I understand that naming a Payee other than
myself does not relieve me of any contractual requirements and responsibilities under the Assisted Housing Relief Agreement. I
understand that DHCD will issue IRS Form-1099 to the Payee.
D. State-Financing Information

□ Elderly Rental Housing Program □ Low Income Housing Tax Credits □ Multifamily Bond Program □ MD -Base Realignment
□ Partnership Rental Housing Program □ Rental Housing Program □ Rental Housing Works □ Other

Owner Signature: ____Trevor Alexander___________________________________________________ Date: ___8/31/2020________

Payee Signature: ________Hameed Hassan______________________________________________ Date:


___8/31/2020_________

AGENT AUTHORIZATION

If there is an Agent/Manager for this property that is not the Owner or Payee that may act on the Owner’s behalf
provide the following information:

Agent/Company Name: ______Southern Management Corporation_________________________

Agent Phone Number: _______ (301)559-8826__________________________________________

Agent Email: ________hhassan@smcmail.com__________________________________________

A copy of the agent or management agreement between the Owner and the Agent must be provided. If the Owner has
provided the management agreement to DHCD previously, it does not need to be resubmitted.

If an Agent or Management Agreement is not available. The legal Owner must complete the form below:

I, _Trevor Alexander_______________________________________________________ (owner name)

hereby authorize ___Hameed Hassan________________________________________ (agent name),


known hereafter as my Agent, to conduct business and enter into contractual agreements with the
Maryland Department of Housing and Community Development on my behalf.

Legal Owner Signature: ____Trevor Alexander____________________________________________


Date: ____8/31/2020__________________________________

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