Landlord Declaration Form: Heating Assistance Rebate Program

If you're applying for a rebate through the Heating Assistance Rebate Program, you need to submit the Landlord Declaration Form if you rent and pay for your own electric heat.

Use the Landlord Declaration Form if you rent and pay for your own heat. You need to submit the form as part of the Heating Assistance Rebate Program application process. The electric heat cannot be included in your rent.

Before you start

Make sure your landlord or superintendent is available to sign the form.

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