RENTAL UNIT REGISTRATION 2020

Date:

MonthDayYear
Date
Type of Rental Registration*

NewRenewal
Type of ownership on the deed*

IndividualLLCIncorporationOther
LLC or Incorporation or Other Ownership Name*
Rental Property Owner Name*

First NameLast Name
Rental Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner or Corporate Officer Address (We will not accept a P.O. Box)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Owner County of Residence*

Erie CountyNiagara CountyGenesee CountyOther
Owner Phone number*

Area CodePhone Number
Owner E-mail*
example@example.com
I would like a secondary representative listed for contact purposes. **Owner of record still holds all responsibility for the property***

YesNo
REPRESENTATIVE REQUIRED

If the owner does not reside within Erie, Niagara, or Genesee County, they must appoint an local representative that can take responsbility for the property.
Agent Name*
Representative Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Representative Phone Number*

Area CodePhone Number
Representative E-mail*
example@example.com
Rental Unit Information

** If rooms are rented individually they are considered a unit, if Not applicable enter 0.**
Number of Units - Long Term Non Owner Occupied (> 30 Days) *
Enter Zero (0) if NA
Number of Units - Long Term Owner Occupied (> 30 Days) *
Enter Zero (0) if NA
Number of Units- Short Term Non Owner Occupied ( 30 Days Max ) *
Enter Zero (0) if NA
Number of Units- Short Term Owner Occupied ( 30 Days Max ) *
Enter Zero (0) if NA
Building Type*
Corporate Officer/Other owners or contacts:

**Officer information is required for all corporations or LLC's
Contact 2 Name

First NameLast Name
Contact 2 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact 2 Phone:

Area CodePhone Number
Contact 2 Email:
example@example.com
Contact 3 Name:

First NameLast Name
Contact 3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Contact 3 Email:
example@example.com
Was the property built prior to 1978?*

YesNo
If the property was built prior to 1978 I certify that I the owner is aware of the possibility of lead paint in the property; that the owner is aware of federal disclosure requirements concerning property that may contain lead paint and has complied with federal disclosure requirements; and that the owner is familiar with the use of lead-safe methods during painting, renovation, or repair of the property. Said certification will be made available for completion on the Town of Amherst web page and in the Building Department at Town Hall.
Owner Signature (Sign using your mouse)*

Clear
Should be Empty:

Rental Unit Information

Corporate Officer/Other owners or contacts: