Form must be submitted within 10 days of the property becoming vacant or from the date of notice from the City.

Property Address*

Registration Status

First Notification Revised Information

Remove

Property Tax ID#

Conveyance Document

Deed Book

Deed Book Page

Property Owner

Owner Name

Owner Physical Address

Owner Mailing Address

Owner Daytime Phone

Owner Evening Phone

Owner Email

Local Authorized Representative/Local Property Agent

Rep Business Name

Rep Name

Rep Physical Address

Rep Mailing Address

Rep Daytome Phone

Rep Evening Phone

Rep Email

I hereby attest to the truth and accuracy of the information contined herein. I acknowledge that I have read and am familiar with the requirements of Chapter 21 of the City's Code of ordinances.

Name of Person Submitting this Form*

Phone Number*

Other Attachments