Commonwealth of Massachusetts Emergency Rental Assistance 2022-2023

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Commonwealth of Massachusetts

Emergency Rental Assistance 2022-2023

Tenant Name ________________________

Address _____________________________

City, State, Zip code _________________ ____________________ _________________

Phone / Email __________________ ____________________________________________

SSN/DOB ______________  _____________

Initial ___________________

.

Landlord Name _______________________

Address _____________________________________________________________________

City, State, Zip code __________________ _________________ ____________________

Phone / Email ______________ _______________________________________________________________

Monthly Rent _________________________

Rent in Arrears _______________________

Reason for arrearage

Loss of Job _______________________

Medical __________________

Psychological __________________________

please specify_____________________

.

Application to for Assistance

City/Town/State _________________________

Veterans Administration __________

Church ____________________________

Synagogue _______________________

Mosque ___________________________

RAFT Program ____________________

Section 8 _________________________

Filing with Housing Court _______________ ______________________

©2023



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