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					REQUEST FOR RENT INCREASE
Anoka County HOME Program Project: City: Type: Property Contact: Owner:

Phone #

List only the HOME assisted units that you are requesting an increase in rent. Amount should reflect the contract rent, NOT
including the amount provided for utility allowance.

High HOME

Unit Size Efficiency 1 Bedroom 2 Bedrooms 3 Bedrooms 4 Bedrooms Other ( ) Bedrooms

# units

Unit # (s)

Current Rent

Low HOME

# units

Unit # (s)

Current Rent

REQUESTED date of increase High * HOME NEW Rent Requested Low * HOME NEW Rent Requested

Unit Size Efficiency 1 Bedroom 2 Bedrooms 3 Bedrooms 4 Bedrooms Other ( ) Bedrooms

# units

Unit # (s)

# units

Unit # (s)

$ 600 $ 707 $ 858 $ 1,123 $ 1,262 $1,451 1,641

$ 600 $ 707 $ 858 $ 1,020 $ 1,138 $1,255 1,373

* based on 04/28/2007 HOME rent limits

Utility Type Heating Cooking Other Electric Hot Water Trash Collection Refrigerator Range

Propane

Electric

Gas

Oil

Owner Provided

(leave blank)

Tenant Provided

Current Utility Allowance is: Efficiency 1 Bedroom 2 Bedrooms 3 Bedrooms 4 Bedrooms Other ( )

Return form to:

Anoka County Community Development Attention: Merry Kemp Government Center, 7th Floor 2100 Third Avenue Anoka, MN 55303 PH: 763.323.5708 FAX: 763.323.5682 merry.kemp@co.anoka.mn.us

County use only: Approved Initials Date: Denied

Form Revised:

4/12/2007


				
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