City, State ZIP
Address
Phone #
City, State ZIP
Mortgage Holder(s) Information
Name
Phone #
Email
Address
Corporation Name
Address
Name
Representative Name
Does the property have a managing agent?
Phone #
Name
Address
Please add the names and addresses of all record owners of the building or the rental business (including all general partners in the case of a partnership).
Address
Email
If the record owner is a corporation, please add the names and addresses of the registered agent and of the corporate officers.
Managing Agent Information
Does the property have a maintenance provider?
Address
City, State ZIP
Unit #
Corporate Information
Maintenance Provider Information
Are there additional owners/partners?
Phone #
City, State ZIP
Is the property owner a corporation?
Email
Applicant Information
Email
Record Owner(s) Information
City, State ZIP
Address
Is there a recorded mortgage on the property?
Emergency Contact Information
Email
Phone #
Registered agent same as applicant?
Phone #
Email
Please add the name and address (including dwelling unit, apartment or room number) of the superintendent, janitor, custodian or other person employed to provide regular maintenance service.
Registered Agent Name
Name
City, State ZIP
Phone #
Is the owner a county resident?
City, State ZIP
Name
If there is recorded mortgage on the property, provide the names and addresses of all holders of recorded mortgages on the property.
Email
Please provide the name, address and telephone number of an individual representative of the record owner or managing agent who may be reached or contacted at any time in the event of an emergency affecting the dwelling or any dwelling unit, including such emergencies as the failure of any essential service or system, and who has authority to make emergency decisions concerning the building, including the making of repairs and expenditures.
