Type Full Name :
Sign With Hand
Initial Registration
Attachments
Email *
Water
Agent Name
Address
First Renewal
Status
Block *
Property Identified As
Any Subsequent Renewal
City, State, ZIP
Lienholder in Possession
Phone #
City, State, ZIP
I, the undersigned, hereby affirm that i am duly authorized to act on behalf of all ownership interests in the above-referenced property. I hereby attest/swear that the information contained herein is accurate and complete to the best of my knowledge. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment under the violations section of §132-91.le.
Property Type *
Number of Stories
Name
Email *
{[PNAME]}
$1000.00
Vacant Property Details
$1000.00
Phone Number
Company Name
Account Number
Certification
Fee Schedule
Assessment
Applicant Signature *
Address
Number of Garages
Financial Institution/Bank Information
City, State, ZIP *
Gas
Lot *
Registration Fee
Address *
Email
City, State, ZIP *
Company Name
Phone # *
Email
Company Name
Representative *
Mailing Address *
Name *
Agent/Representative
Property Address
Address *
Unit #
Second Renewal
Utilities
$1000.00
Phone #
Registration Type *
$500.00
Phone # *
Maintenance Company
Contact Agent
Electric
Date of Vacancy *
Square Footage