Housing Choice Voucher Program
500 Broad Street · Newark, NJ 07102
tel (973) 273-6200 · fax (973) 273-6260
www.newarkha.org
MOVE REQUEST FORM
Important! If you wish to move OUTSIDE the City of Newark to another city STOP - this form does
not apply to you. You must complete a Portability Request Form.
All of the following are true:
I have or will have completed my initial lease term by the time I move;
I have not received a Notice of Participant Termination letter from the NHA;
I have not violated my Family Obligations; AND
I have completed and attached a Lease Termination Agreement
OR
I have an emergency that requires me to move (enter details below).
Print Name:
Address:
E-mail Address:
Phone Number:
Alternate Number:
Last four digits of your Social Security Number: XXX-XX
If you need to move due to an emergency, please explain below:
Next Steps:
The NHA will review your request and determine if you are eligible to move. Emergency moves
will be expedited. If the move is approved:
1) The NHA will schedule a briefing appointment to issue you a voucher and a
move packet, valid for 90 days.
2) The completed RTA submitted on your behalf will be reviewed by NHA staff.
3) The selected unit will be subject to NHA approval, including rent reasonableness,
affordability, and a physical inspection of the unit.
4) Once the unit passes inspection, the NHA will contact you and the owner to submit
a signed lease agreement. The NHA will execute a HAP contract with the new owner.
Participant Signature
Date
Rev. 08/14
This completed form MUST be returned to:
Newark Housing Authority Housing Choice Voucher Program
500 Broad Street · Newark, NJ 07102
tel (973) 273-6200 · fax (973) 273-6260
LEASE TERMINATION AGREEMENT
THIS AGREEMENT, entered into this______day of _________________________ , 20
_____________________________________________________________
as
by and between
Owner/Agent,
and
______________________________________ as Tenant(s) shall operate, by mutual agreement, and for the
benefits of all the parties, to fully and completely terminate the lease executed by and between the parties listed
above
on
________________________________
(enter
date
of
lease
agreement).
Tenant(s) hereby agree to vacate the premises located and leased at (enter unit address below):
______________________________________________________________________
on (date) _______________________________________, 20______.
The Tenant agrees to return the unit in a clean and undamaged condition.
The Tenant understands that the Owner/Agent may use the security deposit, in accordance with State
Law, as reimbursement for any unpaid rent, or damages to the unit
The Owner agrees that tenant is current with all rent payments and owes no rent.
The Owner/Agent and Tenant understand that the Tenant is responsible for any rent accrued, or additional
charges as provided by State Law, due to the Tenant’s failure to vacate the premises by date stated above.
THIS AGREEMENT has been entered into voluntarily and knowingly by the parties.
________________________________
__________________________________
Owner/Agent Name (Print)
Tenant Name (Print)
________________________________
Owner/Agent Signature
__________________________________
Tenant Signature
________________________________
Date
__________________________________
Date