Skip to Main Content
Book an Appointment
How Do I...
Select a Category
Great Brookhaven Clean Up
Housing & Human Services
Parks and Recreation
Receiver of Taxes
Recycling and Garbage Collection
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
Landlord Survey - Rent Owed
This form has been modified since it was saved. Please review all fields before submitting.
Please use the form below to complete the survey
The Town of Brookhaven is aware that many tenants may be in arrears due to the pandemic. We are asking you to take a short survey, so the Town can assess the degree of the problem and develop some solutions. If you are owed rent, please continue the survey.
Landlord Email Address
Number of tenants that owe rent (Landlord only)
Average number of months owed
Combined amount owed from all tenants (round to the nearest whole dollar)
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
Submit and Print
* indicates a required field
Slideshow Left Arrow
Slideshow Right Arrow