Worthington Hills, KY - Rental Property Registration Form

Rental Property Address*

Street Address

Street Address Line 2

CityState

Zip Code
Owner Name*

First NameLast Name
Owner's Address*

Street Address

Street Address Line 2

CityState

Zip Code
Owner's Email*
example@example.com
Owner Phone Number *
Have You Registered this Rental Property with Louisville Metro?*

YesNo
Name of Manager*

First NameLast Name
Manager's Address *

Street Address

Street Address Line 2

CityState

Zip Code
Email of Manager *
example@example.com
Phone Number of Manager*
Written Lease*

YesNo
Number of Adults Residing at this Property (18 and older)*
Number of Children Residing at this Property*
Full Names and Relationship of Tenants: *

0/500
Leasing Ending Date

MonthDayYear
Date
Each Property Owner Acknowledges that:
- Residents, tenants, and visitors within our city limits are governed by all laws, codes, regulations, and ordinances of the United States of America, Commonwealth of Kentucky, Jefferson County/Louisville Metro, and the City of Worthington Hills;
- Owners of Rental Property within the City must registered each rental property with the City of Worthington Hills Property Maintenance Commissioner annually, and when there is a tenant change;
- The City of Worthington Hills' Deed of Restrictions provides in part that, "No lot shall be used except for private, single family, residential purposes.".
Owner's Signature*
Date

MonthDayYear
Date
Manager's Signature*
Date

MonthDayYear
Date
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