Form-Blank-FILL-IN-Residential-Rental-Application-for-License-Renewal, Revised

Honesdale Borough / 958 Main Street, Honesdale, PA 18431

Residential Rental Registration and License Application Application is being made for the following: New Application for Residential Property Rental License Fee (per unit) $25.00 Renewal of Residential Property Rental License Fee (per unit): $25.00 Registration fee is applicable for all rental units whether occupied or vacant, except for unit occupied by the owner. License is transferable if the unit is in compliance with all Honesdale Borough Codes. Notification must be made to the Building Code Official ten (10) days prior to date requested for transfer. A new license will be issued to the new owner at that time.

Must Be Renewed on or before JANUARY 1

FEE IS $25.00 PER UNIT- License for - Year: Make payment payable to HONESDALE BOROUGH, 958 Main St., Honesdale, PA 18431. Telephone: 570-253-0731

Year

must be made prior to license issuance.

Property

Tax Map Parcel

of Units at Location

Site Location

Date Property Purchased

Date

of Units at Purchase Date

Date

Non-Rental Unit Certification:

I certify this is not a Residential Rental Unit.

Current of Units at Location

Signature

Telephone

Property Owner Information: (If transfer, list new property owner below. In case of partnership or corporation list information on all names of general partners, corporate officers and registered agent

Name

Address

Street Address Line 2

CityState

Zip Code

Telephone

Owner of Record is a Partnership Owner of Record is a CorporationYesNoYesNo If Owner is not a resident of Honesdale Borough and resides beyond 20 miles of Honesdale Borough, please provide authorized agent's individual information for acceptance of notices from tenant, to issue receipts therefore, and accept / contract service of process on behalf of the record Owner. Authorized Agent for Property:

Name

Telephone

Address: City Custodian / Janitor or Other Individual to Provide Regular Maintenance Service: Name:

City

Address

State

Zip Code

Fax

Name

Telephone

Address

State

Zip Code

Current Tenants (attach listing if needed): Unit/Apt #Tenant Name(s) 1. 2. 3. 4. 5. 6.

Owner / Agent Certification: I hereby certify that all the above information is true to the best of my knowledge, and belief. I am aware that it if the foregoing information is willfully false, that I am subject to penalties and criminal prosecution. Owner Signature(s):

Owner Signatures

Telephone

Agent Signatures

Telephone

*Upon the receipt of a fully completed application, including the list of tenants' names and the appropriate license fee, and provided that the owner is not in violation of the requirements of this chapter or any ordinance or code of the Borough, the Code Enforcement Officer shall issue a license for the property. (163-5-D) Incomplete forms will be returned; license will not be issued until corrected.AN

INSPECTION IS REQUIRED EACH AND EVERY TIME THERE IS A CHANGE IN THE TENANT OF RECORD (163-4-B