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Landlord Verification and Agreement for Program

Participation

Tenant Customer Name: EUGENE E. LAROCQUE

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Property Address: 200 HOFFMAN AVE APT 306, CRANSTON, RI 02920

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Please complete the table below indicating the months and amounts past due:

Rent Charge Type

Month (i.e. late rent, late fees, Amount Owed
court fees, etc.)
SECURITY DEPOSIT SECURITY DEPOSIT $500.00
FIRST MONTH RENT FEE $1,205.00
SECOND MONTH RENT FEE $1,205.00
THIRD MONTH RENT FEE $1,205.00

Total $4,115.00

Landlord Agreement:

I, (Landlord/organization name) NERO WILLIAM T. agree to accept the

amount provided by RentRelief RI. for the above tenant to cover expenses back to April 1, 2020.
Lifeline, Inc.
I further agree to not increase the rent costs prior to December 30, 2020 or to evict the tenant
for nonpayment for the months covered through this assistance program.

______________________________________________ __________________
02/04/2022
Landlord Signature Date

NERO WILLIAM T.
______________________________________________ 401-519-9686
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Landlord Name

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200 Hoffman Ave #502, Cranston, RI 02920 __________________
nerowilliamt@gmail.com
Mailing Address Email Address