2025 long-term affordable tenant occupied rental program

PART III: OWNER

CERTIFICATION

PART II: LONG TERM AFFORDABLE RENTAL TENANT OCCUPIED

RENTAL APPLICATION DEFINITION AND QUALIFICATIONS

PART I: OWNER

INFORMATION

RP Revised 12.01.23

COUNTY OF KAUA'I REAL PROPERTY ASSESSMENT DIVISION

4444 Rice Street Suite A-454 Lihue, HI 96766-1326

808-241-422 4(B) 808-241-6252 (F)

Website: www.kauaipropertytax.com

Email: [email protected]

Tax Map Key No. (4)

- -

(Kaua‘i

)

Zone

Section

Plat

Parcel

CPR

Bldg./Unit #

Owner’s Name:

Mailing Address:

City/State/Zip:

HM/BUS Phone:

Cell Phone:

Email:

1. Definition:

“Long Term Affordable Rental means a dwelling subject to a written lease agreement with a term of (1) year or more and at monthly rent not to

exceed the maximum housing cost based on 90% of the Kaua‘i Median Household Income as set forth in the Kaua‘i County Housing Agency

Affordable Rental Housing Guideline for the year which the owner files his or her application.”(Ordinance No. 1016, Approved August 14, 2017)"

2. Property Identification:

Property Address:

House Number, Street Name and Town

Maximum Allowable Monthly Rental amount:(Please check appropriate description of your unit)

Select number of

bedrooms being

rented with

attached application

Description of unit

with 1 year or longer

rental agreement

Studio

$1,739 $1,505

1-Bedroom

$1,863 $1,604

2-Bedroom

$2,236 $1,907

3-Bedroom

$2,584 $2,192

4-Bedroom

$2,882 $2,407

5-Bedroom

$3,180 $2,641

x x

Signature of Owner (OWNER signature ONLY - NO AGENTS SIGNATURE)

Date

DEPARTMENT USE ONLY: Received date: ________________ Clerk _________________________________________ END YEAR _________

Lease Term Dates (start & end dates )

RENEW__________

Check box for who is responsible for paying utilities

(utility allowance includes electric, gas, water and sewer)

Owner pays all Tenant pays any

2025 LONG-TERM AFFORDABLE TENANT OCCUPIED RENTAL PROGRAM

ANNUAL DEADLINE FILING SEPTEMBER 30th

NOTICE: (1) Changes to any existing Rental/Lease Agreements must have the initials of the tenants, owner or agents.

(2) The application must have the original signature of the Owner, no agents’ signatures. (3) Those submitting Rental/Lease

Agreements expiring October 31st or before, must provide the renewal agreement not later than November 15, 2024.

For applicants who file and are approved for the 2025 tax year, and provided multi-year lease with tenant name, term of lease, if

tenant pays utilities described below, if multi dwellings on the property provide the unit number covered by lease and affordable

rent amount clearly stated in the lease agreement, may consider this application and its approval good for up to three (3) years.

**IMPORTANT: To qualify, you must submit an executed “CURRENT” copy of your Rental Agreement with this application. Each

rental unit that you are applying for must be accompanied by an application and written rental agreement. Rental Agreement and/or

Lease Agreement cannot expire on or before September 30, 2024 to qualify. If you have more than one rental unit on the same

property, ALL rentals must qualify as Long-Term Affordable rentals to benefit the “Owner-Occupied” tax class. Tenants must be the

age 18 years or older; children under the age of majority are not considered legal tenants; renters/lessees must reside on the

property under this applications, as their principal residence.

4. Tenant Contact Information:

Renter’s Name:

Mailing Address:

City/State/Zip:

Home Phone: _______________________ Cell Phone: ________________ Email: _____________________

I certify that the tenant OCCUPIES the property described above as their principal residence. I authorize the County of

Kaua’i to verify my rental, tenant information, or any other information on this application. I, further agree to notify the

Real Property Assessment Division within 30 calendar days if my property is (a) sold, (b) sublet (c) no longer being

leased by the lessee named on the submitted rental agreement residing on the property and/or (d) is no longer being

rented at the affordable rental rate indicated on my application.

ANY PERSON WHO FALSIFIES AND MISREPRESENTS ANY INFORMATION IN MEETING REQUIREMENTS OF CHAPTER

5A-11A.1 SHALL BE FINED $1,000 OR IMPRISONED FOR NOT MORE THAN ONE YEAR OR BOTH.

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