Worthington Hills, KY - Vacant House Registration Form

Property Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is the property a vacant Rental Home?*

YesNo
Is the home registered as a Rental Property with the City of Worthington Hills?*

YesNo
Is the home registered as a Rental Property with Louisville Metro Government?*

YesNo
Is the Property in Foreclosure?*

YesNo
Name of Property Owner or Financial Institution*
Property Owner's or Financial Institution's Address*

Street Address

Street Address Line 2

CityState

Zip Code
Contact's Email *
example@example.com
Contact's Phone Number *
Contact's Signature *
Date

MonthDayYear
Enter the message as it's shown*
Should be Empty: