Washington State Landlord Tenant Statement Form
This form is essential for landlords and property managers in Washington State to record tenant information and eligibility for assistance. It helps document rental agreements and payment details, ensuring compliance with the Department of Social and Health Services requirements. Accurate completion is crucial for efficient processing of social service benefits.
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How do I fill this out?
To fill out this form, begin by entering the tenant's and unit's information in the designated sections. Ensure all fields are completed with accurate and truthful responses, especially regarding rental amounts and adult occupants. If any information is unavailable, indicate 'unknown' instead of leaving any fields empty.

How to fill out the Washington State Landlord Tenant Statement Form?
1
Start with the rental or leased unit and tenant information.
2
Provide accurate rent information and details about payment methods.
3
Indicate utilities information related to the rental unit.
4
Fill out the landlord or manager's details at the bottom of the form.
5
Review all information before submitting to ensure accuracy.
Who needs the Washington State Landlord Tenant Statement Form?
1
Landlords who must document tenant information for assistance programs.
2
Property managers needing to ensure compliance with state regulations.
3
Social service agencies assessing rental eligibility for financial aid.
4
Tenants applying for housing assistance and benefits.
5
Real estate professionals who require documentation for leasing agreements.
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What are the instructions for submitting this form?
To submit the completed form, send it to the Department of Social and Health Services using the following methods: via mail to DSHS, PO Box 11699, Tacoma, WA 98411-9905; by fax to the DSHS fax number provided on the form; or submit it directly at your local DSHS office. Ensure that all information is accurately completed to prevent delays. Review the submission instructions carefully before sending to ensure compliance with all requirements.
What are the important dates for this form in 2024 and 2025?
Important dates for submitting this form will vary based on the specific assistance program deadlines. Generally, it's advisable to complete and submit forms as soon as requested by the Department of Social and Health Services. Ensure that all information is current to avoid potential delays in processing.

What is the purpose of this form?
The Washington State Landlord Tenant Statement Form serves a critical role in establishing eligibility for housing assistance programs. It captures vital information regarding rental agreements, tenant occupancy, and payment details to ensure compliance with regulations. Proper documentation is essential for facilitating access to social services for eligible tenants.

Tell me about this form and its components and fields line-by-line.

- 1. Street Address: The physical address of the rental unit.
- 2. Tenant's Name: Full legal name of the tenant.
- 3. Date Moved In: The date when the tenant first moved into the property.
- 4. Total Rent Amount: The total rental payment due monthly.
- 5. Housing Agency Amount: Any financial assistance provided by a housing agency.
- 6. Names of All Residents: List of adults and children living in the unit.
- 7. Utilities Information: Details about utility payments and providers.
- 8. Landlord/Manager's Information: Contact details for the landlord or property manager.
What happens if I fail to submit this form?
Failing to submit this form can result in delays or denial of housing assistance for eligible tenants. It is crucial to ensure timely and accurate filing to avoid any disruptions in service. Proper submission facilitates smooth processing for all parties involved.
- Eligibility Delays: Incomplete submissions can lead to delays in determining tenant eligibility for assistance programs.
- Documentation Issues: Missing or incorrect information may result in complications for landlords and tenants.
- Compliance Violations: Failure to submit required documents can lead to potential violations of state regulations.
How do I know when to use this form?

- 1. Rental Assistance Applications: Use this form to apply for state-sponsored rental assistance programs.
- 2. Document Tenant Occupancy: Landlords can utilize this form to document all adults and children living in a unit.
- 3. Eligibility Verification: This form is essential for verifying eligibility for housing benefits.
Frequently Asked Questions
How can I access this form?
You can find the Washington State Tenant Statement Form on our website, ready for download.
What if I make a mistake while filling out the form?
You can edit any mistakes using our PDF editor before finalizing your document.
Can I save my work on PrintFriendly?
You can download your edited PDF after making changes, ensuring you have a copy.
Is this form mandatory?
Yes, filling out this form is necessary for compliance with housing assistance programs.
What information do I need to complete the form?
You will need tenant details, rental amounts, and landlord information to complete the form.
How do I submit the completed form?
Simply download the filled-out PDF and submit it via the method outlined in the instructions.
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What devices can I use to fill out this form?
You can use any device with internet access, including smartphones, tablets, and computers.
Why do I need this form?
This form is essential for processing tenant eligibility for social services and documenting rental agreements.