Address
Please provide the following information of an individual/agent who has the authority to make decisions in case of emergency or responsible for making repairs.
City, State, ZIP
Email
Address
Email
Email
Address
Name
Property Owner Information
Type
Phone #
Mailing Address
Representative Information
City, State, ZIP
Phone #
Please note that the information must include the owner-occupant, if the owner lives at the property, and the occupants in the owner-occupied form.
Disclaimer:
- Provide names of all tenants including children.
- Tenants Name needs to be the name recorded on lease.
Tenant(s) Information
Managing Agent Information
Same as Owner?
Phone #
Do they reside within the Town or a ten-mile radius thereof?
Name
If there is recorded mortgage on the property, provide the names and addresses of all holders of recorded mortgages on the property.
Phone #
Name
City, State, ZIP
Mortgage Holder(s) Information
Corporation Name (if applicable)
Same as Managing Agent?
City, State, ZIP
Name
Date of Birth
Emergency Contact Information
Email
Attachments
Pay Later
Pay By Credit Card
Fee Schedule
If you need to make your payment by mail or in person, our office is located at:
Late Fee (if any)
or
Kindly, attach the Floor Plan of the building.
Certification
If you'd like to pay now by Credit Card, click the Submit & Pay Now button below.
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false I am subject to punishment.
- Annual Registration Fee per Unit: $150 per year.
- Late Fee: After March 1st, there is an additional $50 late fee. Then, from April 1st until the end of the next term, the late fee increases to $150.
Application Fee
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
In order to receive your license, you must first pay the above Fee(s).
Applicant Signature
Payment Method