form HUD-52667 (12/97) ref. Handbook 7420.8 Previous editions are obsolete Utility or Service per month cost Heating $ Cooking Other Electric Air Conditioning Water Heating Water Sewer Trash Collection Range/Microwave Refrigerator Other Total $ Locality Unit Type Date (mm/dd/yyyy) Actual Family Allowances To be used by the family to compute allowance. Complete below for the actual unit rented. Name of Family Address of Unit Number of Bedrooms OMB Approval No. 2577-0169 (exp. 9/30/2010) Allowances for Tenant-Furnished Utilities and Other Services U.S. Department of Housing and Urban Development Office of Public and Indian Housing Utility or Service Monthly Dollar Allowances 0 BR 1 BR 2 BR 3 BR 4 BR 5 BR Heating a. Natural Gas b. Bottle Gas c. Oil / Electric d. Coal / Other Cooking a. Natural Gas b. Bottle Gas c. Oil / Electric d. Coal / Other Other Electric Air Conditioning Water Heating a. Natural Gas b. Bottle Gas c. Oil / Electric d. Coal / Other Water Sewer Trash Collection Range/Microwave Refrigerator Other -- specify See Public Reporting Statement and Instructions on back Page 1 of 1 4/1/2012 18 25 33 41 53 60 83 109 150 191 245 286 37 53 68 81 100 110 93 124 165 204 266 285 2 3 4 5 6 7 10 14 18 23 29 35 4 7 8 10 12 14 0 0 0 0 0 0 27 33 39 46 55 61 7 10 14 16 21 23 18 20 23 25 29 32 26 38 50 64 82 93 15 20 26 30 39 45 0 0 0 0 0 0 14 14 16 20 25 32 41 41 43 43 45 51 11 11 11 11 11 11 7 7 7 7 7 7 6 6 6 6 6 6 Stormwater 3 3 3 3 3 3 Adams County Multi Family
Transcript
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 33 41 53 60
83 109 150 191 245 286
37 53 68 81 100 110
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
4 7 8 10 12 14
0 0 0 0 0 0
27 33 39 46 55 61
7 10 14 16 21 23
18 20 23 25 29 32
26 38 50 64 82 93
15 20 26 30 39 45
0 0 0 0 0 0
14 14 16 20 25 32
41 41 43 43 45 51
11 11 11 11 11 11
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 3 3 3 3 3 3
Adams County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 33 41 53 60
83 109 150 191 245 286
33 47 61 74 92 102
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
3 6 7 9 11 13
0 0 0 0 0 0
19 24 29 35 42 47
6 8 11 13 18 21
18 20 23 25 29 32
26 38 50 64 82 93
12 18 23 27 35 40
0 0 0 0 0 0
12 15 17 20 24 30
42 42 43 43 44 49
11 11 11 11 11 11
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 4 4 4 4 4 4
Allen County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 22 29 36 46 52
73 95 130 167 214 249
34 47 61 72 90 100
81 108 144 178 232 248
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
38 45 52 58 67 73
8 11 13 16 21 25
18 20 23 25 29 32
26 38 50 64 82 93
15 21 27 32 40 45
0 0 0 0 0 0
10 11 13 16 19 24
17 18 21 23 25 30
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Bartholomew County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
43 60 76 91 113 126
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 8 9 11 14 17
0 0 0 0 0 0
34 42 49 56 66 72
8 12 15 17 23 27
17 20 23 25 29 32
26 38 50 64 82 93
16 23 30 35 44 49
0 0 0 0 0 0
12 15 20 25 31 37
35 35 36 36 37 42
13 13 13 13 13 13
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Benton County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 33 41 53 60
83 109 150 191 245 286
33 47 61 74 92 102
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
3 6 7 9 11 13
0 0 0 0 0 0
19 24 29 35 42 47
6 8 11 13 18 21
18 20 23 25 29 32
26 38 50 64 82 93
12 18 23 27 35 40
0 0 0 0 0 0
12 13 16 19 24 29
25 25 26 26 26 28
12 12 12 12 12 12
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Blackford County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
38 52 66 78 97 108
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
36 43 50 56 66 72
8 11 14 16 21 24
18 20 23 25 29 32
26 38 50 64 82 93
16 21 26 31 38 42
0 0 0 0 0 0
8 11 14 18 22 26
27 27 31 32 35 40
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 4 4 4 4 4 4
Boone County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 27 35 43 55 62
73 95 130 167 214 249
35 49 62 74 92 103
81 108 144 178 232 248
2 3 5 6 8 9
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
40 47 54 61 70 76
8 11 14 16 22 25
19 22 25 29 34 37
26 38 50 64 82 93
15 21 28 33 41 46
0 0 0 0 0 0
22 27 35 42 53 67
46 46 48 48 48 54
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Brown County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
39 54 69 83 102 114
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
3 5 5 7 9 10
0 0 0 0 0 0
37 44 51 57 66 72
8 11 13 16 21 25
17 20 23 25 29 32
26 38 50 64 82 93
15 21 27 32 39 44
0 0 0 0 0 0
8 12 16 20 25 31
18 22 27 30 35 43
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Carroll County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
45 58 73 87 105 115
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 9 10 12 15 15
0 0 0 0 0 0
35 42 49 56 67 74
8 12 16 19 26 30
17 20 23 25 29 32
26 38 50 64 82 93
18 25 32 34 41 47
0 0 0 0 0 0
13 18 21 25 31 38
15 17 21 24 29 36
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 3 3 3 3 3 3
Cass County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
17 24 32 40 51 57
73 95 130 167 214 249
35 48 62 74 91 102
81 108 144 178 232 248
2 3 4 5 7 8
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
39 46 53 60 69 75
8 11 14 16 22 25
18 21 24 27 31 34
26 38 50 64 82 93
15 21 27 32 40 46
0 0 0 0 0 0
13 16 20 22 26 31
26 26 26 27 30 35
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 3 3 3 3 3 3
Clark County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
43 59 76 91 113 126
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 8 9 11 14 16
0 0 0 0 0 0
40 48 56 62 72 79
9 12 15 17 23 27
18 20 23 25 29 32
26 38 50 64 82 93
16 23 30 35 43 49
0 0 0 0 0 0
13 15 20 24 30 38
20 23 30 37 46 59
13 13 13 13 13 13
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Clay County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
15 21 28 34 44 50
77 101 138 177 227 265
39 54 69 83 102 114
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
37 44 51 57 66 72
8 11 13 16 21 25
18 20 23 25 29 32
26 38 50 64 82 93
15 21 27 32 39 44
0 0 0 0 0 0
10 11 14 18 23 29
18 21 26 30 36 44
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 5 5 5 5 5 5
Clinton County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 27 35 43 55 62
73 95 130 167 214 249
34 47 60 71 88 98
81 108 144 178 232 248
2 3 5 6 8 9
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
33 41 48 55 64 70
8 12 14 16 21 24
19 22 25 29 34 37
26 38 50 64 82 93
15 21 27 31 39 44
0 0 0 0 0 0
14 17 23 28 35 44
38 38 38 38 38 41
13 13 13 13 13 13
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Crawford County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 26 35 43 54 60
73 95 130 167 214 249
36 50 64 77 95 106
81 108 144 178 232 248
2 3 4 6 7 8
10 14 18 23 29 35
5 7 8 11 14 16
0 0 0 0 0 0
40 48 55 62 71 77
9 12 14 17 23 26
19 22 25 28 33 36
26 38 50 64 82 93
16 22 28 34 42 47
0 0 0 0 0 0
18 18 19 22 27 34
24 24 27 28 31 37
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 3 3 3 3 3 3
Daviess County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
28 35 46 57 70 78
73 95 130 167 214 249
40 57 74 90 111 123
81 108 144 178 232 248
3 5 6 8 9 11
10 14 18 23 29 35
5 7 8 11 14 16
0 0 0 0 0 0
35 43 50 56 66 72
8 11 14 16 22 25
19 28 32 37 43 47
26 38 50 64 82 93
15 21 28 33 41 46
0 0 0 0 0 0
7 10 13 15 19 24
16 18 23 28 34 43
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Dearborn County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 22 29 36 46 52
73 95 130 167 214 249
34 47 60 71 88 98
81 108 144 178 232 248
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
40 47 54 60 69 75
8 11 13 15 21 24
18 20 23 25 29 32
26 38 50 64 82 93
14 20 27 31 39 44
0 0 0 0 0 0
17 18 23 29 36 44
27 27 28 28 29 33
4 4 4 4 4 4
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Decatur County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
40 57 74 89 110 123
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
4 7 8 10 13 15
0 0 0 0 0 0
30 36 42 48 57 63
7 10 13 16 22 25
17 20 23 25 29 32
26 38 50 64 82 93
15 21 27 33 42 48
0 0 0 0 0 0
14 15 17 19 22 27
43 43 44 45 48 55
11 11 11 11 11 11
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 1 1 1 1 1 1
Dekalb County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
33 47 61 74 92 102
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
3 6 7 9 11 13
0 0 0 0 0 0
19 24 29 35 42 47
6 8 11 13 18 21
18 20 23 25 29 32
26 38 50 64 82 93
12 18 23 27 35 40
0 0 0 0 0 0
19 21 24 26 29 33
20 20 21 21 22 25
12 12 12 12 12 12
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Delaware County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 26 36 44 56 64
73 95 130 167 214 249
44 62 81 98 121 135
81 108 144 178 232 248
2 3 4 6 7 8
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
33 41 48 55 64 70
8 12 14 16 21 24
17 20 23 26 31 34
26 38 50 64 82 93
15 21 27 31 39 44
0 0 0 0 0 0
16 21 25 29 35 43
29 29 31 31 32 36
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 2 2 2 2 2 2
Dubois County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
40 57 74 89 111 123
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
4 7 8 10 13 15
0 0 0 0 0 0
24 32 38 44 53 59
7 10 13 16 22 25
17 20 23 25 29 32
26 38 50 64 82 93
15 21 28 33 42 48
0 0 0 0 0 0
9 13 16 19 24 30
28 28 28 28 28 32
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Elkhart County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
23 32 44 54 70 79
77 101 138 177 227 265
41 59 77 93 115 128
86 114 153 189 246 264
3 4 5 7 8 10
10 14 18 23 29 35
4 7 8 11 14 16
0 0 0 0 0 0
43 49 55 61 71 77
7 10 14 17 23 26
24 27 31 34 40 44
26 38 50 64 82 93
16 22 29 34 43 50
0 0 0 0 0 0
14 14 16 18 22 27
26 26 26 26 26 26
8 8 8 8 8 8
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 5 5 5 5 5 5
Fayette County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
22 31 41 51 66 74
73 95 130 167 214 249
34 45 57 68 84 93
81 108 144 178 232 248
3 4 5 7 8 10
10 14 18 23 29 35
5 7 8 10 13 14
0 0 0 0 0 0
33 40 48 54 63 69
8 11 14 16 22 25
24 27 31 34 40 44
26 38 50 64 82 93
15 21 27 30 37 42
0 0 0 0 0 0
18 26 32 36 44 53
39 41 46 48 53 62
14 14 14 14 14 14
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 1 1 1 1 1 1
Floyd County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
39 54 68 80 98 109
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 8 8 10 13 15
0 0 0 0 0 0
34 42 49 56 65 72
9 12 14 17 22 24
18 20 23 25 29 32
26 38 50 64 82 93
16 21 27 32 39 44
0 0 0 0 0 0
13 15 17 19 23 28
18 18 19 20 23 28
11 11 11 11 11 11
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Fountain County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
24 33 44 54 68 76
73 95 130 167 214 249
36 50 64 76 93 103
81 108 144 178 232 248
3 4 6 7 9 10
10 14 18 23 29 35
5 7 8 11 14 16
0 0 0 0 0 0
38 45 52 59 68 74
8 11 14 17 22 26
23 27 31 36 42 45
26 38 50 64 82 93
15 22 28 33 42 48
0 0 0 0 0 0
11 12 16 19 24 30
32 32 32 32 32 32
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 1 1 1 1 1 1
Franklin County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
41 57 73 87 106 117
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 11 14 16
0 0 0 0 0 0
37 44 52 58 68 74
9 12 14 17 23 26
17 20 23 25 29 32
26 38 50 64 82 93
16 22 29 34 42 47
0 0 0 0 0 0
10 11 13 16 20 25
20 21 23 24 26 30
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Fulton County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 27 36 44 55 62
73 95 130 167 214 249
38 54 69 83 102 114
81 108 144 178 232 248
2 3 5 6 7 9
10 14 18 23 29 35
5 8 9 11 15 17
0 0 0 0 0 0
35 43 50 57 67 74
8 12 15 18 24 28
19 22 25 29 33 36
26 38 50 64 82 93
16 23 30 36 45 51
0 0 0 0 0 0
14 17 21 26 33 41
39 39 43 43 46 54
6 6 6 6 6 6
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Gibson County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
83 109 150 191 245 286
37 51 66 79 98 109
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
4 7 7 9 12 14
0 0 0 0 0 0
23 29 34 40 48 54
6 9 12 15 20 23
18 20 23 25 29 32
26 38 50 64 82 93
14 20 25 30 38 43
0 0 0 0 0 0
16 17 19 23 27 31
27 27 27 27 27 29
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 5 5 5 5 5 5
Grant County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 26 36 44 56 63
73 95 130 167 214 249
37 52 67 80 98 110
81 108 144 178 232 248
2 3 4 6 7 8
10 14 18 23 29 35
5 8 9 11 14 16
0 0 0 0 0 0
40 48 56 62 72 79
9 12 15 17 23 27
21 24 27 30 35 38
26 38 50 64 82 93
16 23 30 35 43 49
0 0 0 0 0 0
16 17 20 24 30 37
25 25 26 27 30 36
12 12 12 12 12 12
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Greene County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
23 33 44 54 69 77
77 101 138 177 227 265
34 44 55 64 79 89
86 114 153 189 246 264
3 4 5 7 9 10
10 14 18 23 29 35
5 7 7 9 11 13
0 0 0 0 0 0
28 35 42 48 57 62
8 11 13 15 19 21
18 21 25 29 34 38
26 38 50 64 82 93
14 19 23 27 32 35
0 0 0 0 0 0
14 16 19 22 26 31
31 31 31 31 31 33
13 13 13 13 13 13
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 4 4 4 4 4 4
Hamilton County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
36 49 62 73 91 101
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 9 12 14
0 0 0 0 0 0
34 41 47 53 62 68
8 11 13 15 20 23
18 20 23 25 29 32
26 38 50 64 82 93
15 20 25 29 35 40
0 0 0 0 0 0
9 9 10 13 16 20
20 20 20 20 20 21
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 2 2 2 2 2 2
Hancock County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
23 32 42 52 66 74
73 95 130 167 214 249
34 45 57 68 84 93
81 108 144 178 232 248
3 4 5 7 9 10
10 14 18 23 29 35
5 7 8 10 13 14
0 0 0 0 0 0
33 40 48 54 63 69
8 11 14 16 22 25
20 24 27 31 37 41
26 38 50 64 82 93
15 21 27 30 37 42
0 0 0 0 0 0
21 25 30 34 40 48
27 27 33 36 42 51
9 9 9 9 9 9
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Harrison County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
35 47 60 71 87 97
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
4 7 7 9 12 13
0 0 0 0 0 0
34 41 48 53 62 68
7 10 13 15 19 22
18 20 23 25 29 32
26 38 50 64 82 93
14 19 24 28 34 38
0 0 0 0 0 0
13 16 19 21 25 30
26 26 26 26 26 28
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 5 5 5 5 5 5
Hendricks County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
36 50 63 76 94 104
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
4 6 7 9 12 14
0 0 0 0 0 0
34 41 47 53 61 67
8 10 12 14 20 23
18 20 23 25 29 32
26 38 50 64 82 93
13 19 25 29 36 41
0 0 0 0 0 0
10 11 13 16 20 22
29 29 29 29 29 31
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Henry County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
37 50 62 73 91 101
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 7 7 9 12 14
0 0 0 0 0 0
30 38 46 52 60 66
9 12 13 15 20 23
17 20 23 25 29 32
26 38 50 64 82 93
14 20 25 30 36 40
0 0 0 0 0 0
17 20 24 28 34 42
31 31 32 32 34 38
9 9 9 9 9 9
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 2 2 2 2 2 2
Howard County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
83 109 150 191 245 286
48 66 84 98 119 131
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
6 9 10 12 16 18
0 0 0 0 0 0
37 46 55 62 74 81
10 14 17 20 26 30
18 20 23 25 29 32
26 38 50 64 82 93
19 26 33 39 48 55
0 0 0 0 0 0
11 19 24 27 32 39
10 16 22 26 33 42
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Huntington County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
17 24 32 40 51 57
73 95 130 167 214 249
34 47 60 72 89 99
81 108 144 178 232 248
2 3 4 5 7 8
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
32 39 46 52 61 67
8 11 13 16 21 24
18 21 24 27 31 34
26 38 50 64 82 93
15 21 27 31 39 44
0 0 0 0 0 0
15 20 25 31 39 49
38 38 39 39 40 45
8 8 8 8 8 8
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Jackson County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
20 27 36 44 56 63
83 109 150 191 245 286
43 61 80 97 120 133
93 124 165 204 266 285
2 3 4 5 7 8
10 14 18 23 29 35
4 8 9 11 14 17
0 0 0 0 0 0
37 45 52 58 68 75
7 11 15 17 24 27
14 17 20 22 27 30
26 38 50 64 82 93
16 23 30 35 45 52
0 0 0 0 0 0
27 29 35 39 46 56
17 17 17 17 17 19
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 3 3 3 3 3 3
Jasper County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
21 30 40 50 64 72
83 109 150 191 245 286
37 53 68 81 100 110
93 124 165 204 266 285
2 3 4 6 7 8
10 14 18 23 29 35
4 7 8 10 12 14
0 0 0 0 0 0
27 33 39 46 55 61
7 10 14 16 21 23
21 24 27 30 35 38
26 38 50 64 82 93
15 20 26 30 39 45
0 0 0 0 0 0
10 11 14 18 23 29
26 26 28 28 30 34
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Jay County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 22 29 36 46 52
73 95 130 167 214 249
34 47 60 72 89 99
81 108 144 178 232 248
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
32 39 46 52 61 67
8 11 13 16 21 24
18 20 23 25 29 32
26 38 50 64 82 93
15 21 27 31 39 44
0 0 0 0 0 0
7 8 10 12 15 19
16 16 21 25 29 36
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Jefferson County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 27 36 44 55 62
73 95 130 167 214 249
34 47 60 72 89 99
81 108 144 178 232 248
2 3 4 6 7 9
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
32 39 46 52 61 67
8 11 13 16 21 24
19 22 25 28 33 36
26 38 50 64 82 93
15 21 27 31 39 44
0 0 0 0 0 0
24 24 28 32 37 45
20 20 20 24 29 38
4 4 4 4 4 4
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 4 4 4 4 4 4
Jennings County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
37 50 63 75 93 104
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 9 12 14
0 0 0 0 0 0
32 39 46 52 62 68
8 11 14 16 20 23
18 20 23 25 29 32
26 38 50 64 82 93
15 20 25 30 36 41
0 0 0 0 0 0
22 28 32 35 42 50
23 23 24 24 24 26
12 12 12 12 12 12
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 7 7 7 7 7 7
Johnson County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 41 52 59
73 95 130 167 214 249
31 43 55 66 81 90
81 108 144 178 232 248
2 3 4 5 7 8
10 14 18 23 29 35
4 6 7 9 12 14
0 0 0 0 0 0
36 43 49 55 63 68
8 10 12 14 19 22
19 22 25 28 32 35
26 38 50 64 82 93
13 19 25 29 36 40
0 0 0 0 0 0
11 13 16 19 23 28
37 37 39 39 40 45
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 3 3 3 3 3 3
Knox County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
40 58 75 89 110 123
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 8 8 11 14 16
0 0 0 0 0 0
31 39 46 53 62 69
8 12 14 17 23 26
17 20 23 25 29 32
26 38 50 64 82 93
15 22 29 34 42 48
0 0 0 0 0 0
17 20 23 25 28 33
28 28 28 28 28 28
5 5 5 5 5 5
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Kosciusko County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
40 56 73 89 110 122
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
4 7 8 10 13 15
0 0 0 0 0 0
34 41 47 53 62 68
7 10 13 16 22 25
17 20 23 25 29 32
26 38 50 64 82 93
15 21 27 32 42 48
0 0 0 0 0 0
12 13 17 18 21 25
21 21 23 23 25 28
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 8 8 8 8 8 8
LaGrange County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
47 67 87 105 130 144
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 8 9 12 16 18
0 0 0 0 0 0
29 39 47 54 64 71
8 12 16 19 26 29
17 20 23 25 29 32
26 38 50 64 82 93
18 25 32 38 49 56
0 0 0 0 0 0
15 18 21 24 29 35
22 22 23 23 24 28
15 15 15 15 15 15
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 4 4 4 4 4 4
Lake County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
39 55 72 87 107 119
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
4 7 8 10 13 15
0 0 0 0 0 0
31 38 44 49 58 64
7 10 13 16 21 24
17 20 23 25 29 32
26 38 50 64 82 93
14 21 27 32 40 46
0 0 0 0 0 0
15 16 19 22 26 33
22 22 22 22 23 26
8 8 8 8 8 8
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
LaPorte County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 22 29 36 46 52
73 95 130 167 214 249
34 47 60 72 89 99
81 108 144 178 232 248
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
32 39 46 52 61 67
8 11 13 16 21 24
18 20 23 25 29 32
26 38 50 64 82 93
15 21 27 31 39 44
0 0 0 0 0 0
15 20 25 30 37 46
16 16 19 20 22 26
9 9 9 9 9 9
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Lawrence County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
38 53 68 81 101 112
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
25 32 38 45 54 60
8 11 13 16 21 24
18 20 23 25 29 32
26 38 50 64 82 93
15 21 26 31 39 44
0 0 0 0 0 0
10 11 13 17 21 26
31 31 31 31 31 31
9 9 9 9 9 9
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Madison County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
13 18 23 28 36 40
77 101 138 177 227 265
30 39 47 55 68 76
86 114 153 189 246 264
1 2 3 4 5 6
10 14 18 23 29 35
4 7 7 8 10 11
0 0 0 0 0 0
26 32 38 44 53 59
7 10 13 15 17 19
17 19 21 23 26 28
26 38 50 64 82 93
15 17 21 24 27 30
0 0 0 0 0 0
13 16 18 20 23 28
29 29 29 29 29 31
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 9 9 9 9 9 9
Marion County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
46 64 81 96 117 129
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 8 9 12 15 18
0 0 0 0 0 0
35 44 51 58 68 75
8 12 16 19 25 29
17 20 23 25 29 32
26 38 50 64 82 93
17 25 32 37 46 52
0 0 0 0 0 0
11 11 13 16 20 25
21 21 21 21 21 24
15 15 15 15 15 15
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 2 2 2 2 2 2
Marshall County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
17 24 32 40 51 57
73 95 130 167 214 249
36 50 64 77 95 106
81 108 144 178 232 248
2 3 4 5 7 8
10 14 18 23 29 35
5 7 8 11 14 16
0 0 0 0 0 0
40 48 55 62 71 77
9 12 14 17 23 26
18 21 24 27 31 34
26 38 50 64 82 93
16 22 28 34 42 47
0 0 0 0 0 0
14 17 22 28 36 44
43 43 43 43 43 43
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Martin County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 33 41 53 60
73 95 130 167 214 249
41 54 67 80 98 108
81 108 144 178 232 248
2 3 4 5 6 7
10 14 18 23 29 35
5 8 9 11 13 15
0 0 0 0 0 0
32 40 47 54 64 70
9 12 14 17 23 26
18 20 23 25 29 32
26 38 50 64 82 93
16 22 29 32 38 43
0 0 0 0 0 0
9 9 11 13 16 20
25 25 26 27 29 34
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 4 4 4 4 4 4
Miami County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 22 29 36 46 52
73 95 130 167 214 249
37 53 68 81 101 112
81 108 144 178 232 248
2 3 4 5 6 7
10 14 18 23 29 35
5 8 9 11 14 17
0 0 0 0 0 0
43 51 58 65 74 81
8 12 15 17 23 27
18 20 23 25 29 32
26 38 50 64 82 93
16 23 30 35 44 50
0 0 0 0 0 0
10 12 14 16 20 25
32 32 32 32 32 34
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 3 3 3 3 3 3
Monroe County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
39 54 68 80 98 109
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 8 8 10 13 15
0 0 0 0 0 0
34 42 49 56 65 72
9 12 14 17 22 24
18 20 23 25 29 32
26 38 50 64 82 93
18 23 28 33 43 49
0 0 0 0 0 0
20 26 29 32 37 44
5 8 10 12 15 20
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Montgomery County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
37 50 63 75 93 104
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 9 12 14
0 0 0 0 0 0
35 42 49 55 64 70
8 11 14 16 20 23
18 20 23 25 29 32
26 38 50 64 82 93
15 20 25 30 36 41
0 0 0 0 0 0
15 17 18 20 23 27
21 21 23 23 23 26
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 6 6 6 6 6 6
Morgan County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
46 63 81 97 120 134
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 8 9 12 15 18
0 0 0 0 0 0
30 39 46 53 63 70
8 12 15 18 25 29
17 20 23 25 29 32
26 38 50 64 82 93
17 24 32 37 46 52
0 0 0 0 0 0
8 14 19 24 31 38
18 18 18 18 18 18
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Newton County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
40 57 74 89 110 123
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
4 7 8 10 13 15
0 0 0 0 0 0
26 33 39 45 55 61
7 10 13 16 22 25
17 20 23 25 29 32
26 38 50 64 82 93
15 21 28 33 42 48
0 0 0 0 0 0
12 14 16 20 26 32
18 18 18 18 19 22
12 12 12 12 12 12
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Noble County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
26 35 46 57 70 78
73 95 130 167 214 249
40 57 74 90 111 123
81 108 144 178 232 248
3 5 6 8 9 11
10 14 18 23 29 35
5 7 8 11 14 16
0 0 0 0 0 0
35 43 50 56 66 72
8 11 14 16 22 25
23 28 32 37 43 47
26 38 50 64 82 93
15 21 28 33 41 46
0 0 0 0 0 0
10 14 16 18 21 26
29 29 30 30 31 34
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Ohio County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
17 24 32 40 51 57
73 95 130 167 214 249
36 50 64 76 95 105
81 108 144 178 232 248
2 3 4 5 7 8
10 14 18 23 29 35
5 7 8 11 14 16
0 0 0 0 0 0
37 44 52 58 67 74
9 12 14 17 22 26
18 21 24 27 31 34
26 38 50 64 82 93
15 22 28 33 42 47
0 0 0 0 0 0
22 24 27 32 40 49
29 29 30 33 37 44
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Orange County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 26 36 44 55 62
77 101 138 177 227 265
43 59 76 91 113 126
86 114 153 189 246 264
2 3 4 5 7 8
10 14 18 23 29 35
5 8 9 11 14 16
0 0 0 0 0 0
40 48 56 62 72 79
9 12 15 17 23 27
19 21 24 27 32 35
26 38 50 64 82 93
16 23 30 35 43 49
0 0 0 0 0 0
18 18 20 23 28 34
28 33 40 43 50 61
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Owen County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
40 56 72 86 106 118
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 10 13 16
0 0 0 0 0 0
34 42 49 56 65 71
8 11 14 16 22 25
18 20 23 25 29 32
26 38 50 64 82 93
15 22 28 33 41 46
0 0 0 0 0 0
17 17 22 25 31 37
28 28 33 39 47 59
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 6 6 6 6 6 6
Parke County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
22 30 41 51 65 74
73 95 130 167 214 249
31 44 58 70 86 96
81 108 144 178 232 248
3 4 5 6 8 10
10 14 18 23 29 35
4 6 7 9 12 14
0 0 0 0 0 0
25 31 36 41 50 55
6 9 12 14 19 22
24 27 31 34 40 43
26 38 50 64 82 93
13 19 25 29 37 43
0 0 0 0 0 0
12 14 16 18 22 27
25 25 25 25 27 32
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 2 2 2 2 2 2
Perry County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 26 35 43 56 63
73 95 130 167 214 249
38 54 69 83 102 114
81 108 144 178 232 248
2 3 4 6 7 8
10 14 18 23 29 35
5 9 10 12 16 19
0 0 0 0 0 0
35 40 49 57 68 75
8 13 16 20 27 31
21 24 27 30 35 38
26 38 50 64 82 93
16 26 33 40 49 56
0 0 0 0 0 0
14 17 23 28 35 43
33 33 33 33 33 36
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Pike County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
41 59 77 93 115 128
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
4 7 8 11 14 16
0 0 0 0 0 0
36 44 51 57 66 73
7 10 14 17 23 26
17 20 23 25 29 32
26 38 50 64 82 93
16 22 29 34 44 50
0 0 0 0 0 0
17 20 23 25 29 36
27 27 29 29 31 36
16 16 16 16 16 16
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 8 8 8 8 8 8
Porter County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 41 52 59
73 95 130 167 214 249
42 59 76 91 112 125
81 108 144 178 232 248
2 3 4 5 7 8
10 14 18 23 29 35
6 9 10 12 16 19
0 0 0 0 0 0
32 40 49 57 68 75
10 13 16 20 27 31
19 22 25 28 32 35
26 38 50 64 82 93
18 26 33 40 49 56
0 0 0 0 0 0
17 17 23 29 38 48
21 21 24 29 36 47
9 9 9 9 9 9
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Posey County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
44 61 78 93 116 129
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 8 9 11 15 17
0 0 0 0 0 0
37 45 53 59 69 76
8 12 15 18 24 28
17 20 23 25 29 32
26 38 50 64 82 93
17 24 31 36 45 50
0 0 0 0 0 0
20 20 24 31 39 49
38 38 38 38 38 38
12 12 12 12 12 12
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Pulaski County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
35 47 60 71 87 97
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
4 7 7 9 12 13
0 0 0 0 0 0
34 41 48 53 62 68
7 10 13 15 19 22
18 20 23 25 29 32
26 38 50 64 82 93
14 19 24 28 34 38
0 0 0 0 0 0
10 12 16 19 24 30
41 41 41 41 42 49
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Putnam County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
20 28 37 46 59 67
77 101 138 177 227 265
37 52 67 80 99 110
86 114 153 189 246 264
2 3 4 6 7 8
10 14 18 23 29 35
4 7 8 10 12 14
0 0 0 0 0 0
31 37 44 49 58 63
7 10 13 15 20 23
21 24 27 30 35 38
26 38 50 64 82 93
14 20 26 30 38 43
0 0 0 0 0 0
14 17 19 21 24 28
41 41 41 41 41 41
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Randolph County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
21 29 39 48 62 70
73 95 130 167 214 249
40 57 74 90 111 123
81 108 144 178 232 248
3 4 5 6 8 9
10 14 18 23 29 35
5 7 8 11 14 16
0 0 0 0 0 0
35 43 50 56 66 72
8 11 14 16 22 25
19 22 26 29 35 38
26 38 50 64 82 93
15 21 28 33 41 46
0 0 0 0 0 0
14 15 18 22 28 36
24 24 24 25 28 34
8 8 8 8 8 8
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 2 2 2 2 2 2
Ripley County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
21 29 39 48 61 69
77 101 138 177 227 265
41 57 72 84 102 113
86 114 153 189 246 264
2 3 5 6 8 9
10 14 18 23 29 35
5 7 8 11 14 16
0 0 0 0 0 0
36 43 51 57 67 73
8 12 14 16 22 26
19 22 25 29 33 37
26 38 50 64 82 93
15 22 28 33 41 47
0 0 0 0 0 0
20 23 27 31 36 43
19 20 22 23 25 29
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Rush County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
38 54 70 85 105 117
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
4 7 8 10 13 15
0 0 0 0 0 0
23 30 36 42 51 56
7 10 13 16 21 24
17 20 23 25 29 32
26 38 50 64 82 93
15 20 26 31 40 46
0 0 0 0 0 0
14 14 15 15 16 18
42 42 42 42 42 42
9 9 9 9 9 9
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
St. Joseph County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 27 36 44 55 62
73 95 130 167 214 249
34 47 60 72 89 99
81 108 144 178 232 248
2 3 4 6 7 9
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
32 39 46 52 61 67
8 11 13 16 21 24
19 22 25 28 33 36
26 38 50 64 82 93
15 21 27 31 39 44
0 0 0 0 0 0
10 14 17 20 25 30
17 17 17 17 17 20
8 8 8 8 8 8
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Scott County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
21 29 39 48 61 69
77 101 138 177 227 265
41 57 72 84 102 113
86 114 153 189 246 264
2 3 5 6 8 9
10 14 18 23 29 35
5 7 8 11 14 16
0 0 0 0 0 0
36 43 51 57 67 73
8 12 14 16 22 26
19 22 25 29 33 37
26 38 50 64 82 93
15 22 28 33 41 47
0 0 0 0 0 0
16 22 26 29 34 40
23 23 23 23 23 23
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 6 6 6 6 6 6
Shelby County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
20 28 38 46 59 66
73 95 130 167 214 249
45 64 84 101 125 140
81 108 144 178 232 248
2 4 5 6 8 9
10 14 18 23 29 35
5 9 11 13 17 20
0 0 0 0 0 0
35 43 50 56 66 72
8 11 14 16 22 25
20 24 27 30 35 39
26 38 50 64 82 93
15 21 28 33 41 46
0 0 0 0 0 0
17 22 26 30 36 43
32 32 34 35 38 44
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Spencer County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
41 59 77 93 115 128
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
4 7 8 11 14 16
0 0 0 0 0 0
36 44 51 57 66 73
7 10 14 17 23 26
17 20 23 25 29 32
26 38 50 64 82 93
16 22 29 34 44 50
0 0 0 0 0 0
10 10 10 12 16 20
38 38 38 38 38 38
12 12 12 12 12 12
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Starke County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 42 53 60
83 109 150 191 245 286
41 57 73 87 108 120
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
4 7 8 11 14 16
0 0 0 0 0 0
30 39 45 51 61 67
7 11 14 17 23 26
17 20 23 25 29 32
26 38 50 64 82 93
16 22 29 34 42 47
0 0 0 0 0 0
11 13 14 16 19 23
25 25 27 29 33 40
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 3 3 3 3 3 3
Steuben County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 26 35 44 56 63
73 95 130 167 214 249
31 43 55 66 81 90
81 108 144 178 232 248
2 3 4 6 7 8
10 14 18 23 29 35
4 6 7 9 12 14
0 0 0 0 0 0
36 43 49 55 63 68
8 10 12 14 19 22
22 25 28 32 36 39
26 38 50 64 82 93
13 19 25 29 36 40
0 0 0 0 0 0
20 26 29 32 37 44
19 25 31 35 41 50
12 12 12 12 12 12
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Sullivan County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
20 29 39 48 61 68
73 95 130 167 214 249
40 57 74 90 111 123
81 108 144 178 232 248
2 4 5 6 8 9
10 14 18 23 29 35
5 7 8 11 14 16
0 0 0 0 0 0
35 43 50 56 66 72
8 11 14 16 22 25
19 22 26 29 34 38
26 38 50 64 82 93
15 21 28 33 41 46
0 0 0 0 0 0
14 16 20 23 28 34
18 18 20 21 24 29
14 14 14 14 14 14
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 1 1 1 1 1 1
Switzerland County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
83 109 150 191 245 286
39 54 68 80 98 109
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 8 8 10 13 15
0 0 0 0 0 0
34 42 49 56 65 72
9 12 14 17 22 24
18 20 23 25 29 32
26 38 50 64 82 93
16 21 27 32 39 44
0 0 0 0 0 0
9 11 13 14 17 20
25 25 26 26 28 33
9 9 9 9 9 9
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Tippecanoe County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
15 21 28 34 44 50
77 101 138 177 227 265
37 50 62 73 91 101
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 7 7 9 12 14
0 0 0 0 0 0
30 38 46 52 60 66
9 12 13 15 20 23
18 20 23 25 29 32
26 38 50 64 82 93
14 20 25 30 36 40
0 0 0 0 0 0
19 20 23 26 31 37
21 21 22 22 22 25
13 13 13 13 13 13
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Tipton County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
23 32 44 54 70 79
77 101 138 177 227 265
39 54 69 83 103 114
86 114 153 189 246 264
3 4 5 7 8 10
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
36 43 51 57 66 72
8 11 13 16 21 25
24 27 31 34 40 44
26 38 50 64 82 93
15 21 27 32 40 45
0 0 0 0 0 0
9 12 16 18 22 27
48 48 50 56 66 82
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Union County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 34 41 52 59
73 95 130 167 214 249
52 75 98 118 145 162
81 108 144 178 232 248
2 3 4 5 7 8
10 14 18 23 29 35
6 11 12 15 20 23
0 0 0 0 0 0
34 43 52 61 75 84
10 15 20 24 33 38
19 22 25 28 32 35
26 38 50 64 82 93
23 32 41 49 63 72
0 0 0 0 0 0
7 10 12 13 15 18
36 36 38 38 39 44
12 12 12 12 12 12
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Vanderburgh County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
37 50 62 73 91 101
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 7 7 9 12 14
0 0 0 0 0 0
30 38 46 52 60 66
9 12 13 15 20 23
18 20 23 25 29 32
26 38 50 64 82 93
14 20 25 30 36 40
0 0 0 0 0 0
20 22 24 26 29 33
32 32 33 35 39 47
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Vermillion County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
37 50 62 73 91 101
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 7 7 9 12 14
0 0 0 0 0 0
30 38 46 52 60 66
9 12 13 15 20 23
18 20 23 25 29 32
26 38 50 64 82 93
14 20 25 30 36 40
0 0 0 0 0 0
19 25 29 32 37 43
21 21 21 21 21 24
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Vigo County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 33 41 53 60
83 109 150 191 245 286
42 57 70 81 98 110
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 8 9 11 14 16
0 0 0 0 0 0
33 41 49 55 65 72
9 12 15 17 23 27
18 20 23 25 29 32
26 38 50 64 82 93
16 23 29 34 41 45
0 0 0 0 0 0
16 17 19 22 26 32
18 18 18 18 21 26
12 12 12 12 12 12
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 4 4 4 4 4 4
Wabash County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
16 23 31 38 49 55
77 101 138 177 227 265
40 56 72 85 106 118
86 114 153 189 246 264
2 3 4 5 6 7
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
38 46 53 59 68 75
8 11 14 16 22 25
18 20 23 25 29 32
26 38 50 64 82 93
15 21 28 33 41 46
0 0 0 0 0 0
7 14 18 21 34 39
18 20 23 24 27 32
0 0 0 0 0 0
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Warren County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
22 31 41 51 65 73
73 95 130 167 214 249
41 57 74 89 110 123
81 108 144 178 232 248
3 4 5 7 9 10
10 14 18 23 29 35
5 8 10 12 16 18
0 0 0 0 0 0
35 43 51 58 69 76
9 13 16 19 26 29
20 23 27 31 36 40
26 38 50 64 82 93
18 25 32 38 48 55
0 0 0 0 0 0
18 21 25 29 35 42
43 43 43 43 43 48
8 8 8 8 8 8
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 5 5 5 5 5 5
Warrick County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
19 27 36 44 55 62
73 95 130 167 214 249
34 47 60 72 89 99
81 108 144 178 232 248
2 3 4 6 7 9
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
32 39 46 52 61 67
8 11 13 16 21 24
19 22 25 28 33 36
26 38 50 64 82 93
15 21 27 31 39 44
0 0 0 0 0 0
15 16 20 25 32 40
18 18 22 23 26 32
6 6 6 6 6 6
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Washington County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
20 28 37 46 59 67
77 101 138 177 227 265
39 54 69 83 103 114
86 114 153 189 246 264
2 3 4 6 7 8
10 14 18 23 29 35
5 7 8 10 13 15
0 0 0 0 0 0
36 43 51 57 66 72
8 11 13 16 21 25
21 24 27 30 35 38
26 38 50 64 82 93
15 21 27 32 40 45
0 0 0 0 0 0
12 13 15 17 19 23
27 27 27 27 27 27
10 10 10 10 10 10
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 0 0 0 0 0 0
Wayne County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 33 41 53 60
83 109 150 191 245 286
46 65 83 99 119 132
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 9 9 12 15 18
0 0 0 0 0 0
32 39 46 54 65 72
8 12 16 19 25 29
18 20 23 25 29 32
26 38 50 64 82 93
18 25 31 37 48 55
0 0 0 0 0 0
11 11 15 18 23 29
34 34 34 34 34 37
14 14 14 14 14 14
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 8 8 8 8 8 8
Wells County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
Page 1 of 1
4/1/2012
18 25 33 41 53 60
83 109 150 191 245 286
44 61 78 93 116 129
93 124 165 204 266 285
2 3 4 5 6 7
10 14 18 23 29 35
5 8 9 11 15 17
0 0 0 0 0 0
37 45 53 59 69 76
8 12 15 18 24 28
18 20 23 25 29 32
26 38 50 64 82 93
17 24 31 36 45 50
0 0 0 0 0 0
18 19 23 26 31 37
26 30 36 39 44 54
7 7 7 7 7 7
7 7 7 7 7 7
6 6 6 6 6 6
Stormwater 2 2 2 2 2 2
White County Multi Family
form HUD-52667 (12/97)ref. Handbook 7420.8Previous editions are obsolete
Utility or Service per month costHeating $CookingOther ElectricAir ConditioningWater HeatingWaterSewerTrash CollectionRange/MicrowaveRefrigeratorOther
Total $
Locality Unit Type Date (mm/dd/yyyy)
Actual Family Allowances To be used by the family to compute allowance.Complete below for the actual unit rented.
Name of Family
Address of Unit
Number of Bedrooms
OMB Approval No. 2577-0169(exp. 9/30/2010)Allowances for
Tenant-Furnished Utilitiesand Other Services
U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing
Utility or Service Monthly Dollar Allowances0 BR 1 BR 2 BR 3 BR 4 BR 5 BR
Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Cooking a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Other Electric
Air Conditioning
Water Heating a. Natural Gas
b. Bottle Gas
c. Oil / Electric
d. Coal / Other
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Other -- specify
See Public Reporting Statement and Instructions on back
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