• ** FIELDS HIGHLIGHTED IN RED ARE REQUIRED

• RENTAL PROPERTY ADDRESS:(*REQUIRED)  

• DESCRIPTION OF RENTAL PROPERTY:

• County PIN#:	*if available
  Type of Rental Dwelling?*Required	Please choose one Single Family Rental Dwelling Multi-family Rental Dwelling
  Section 8? *Required	Please choose one Yes, Section 8 No, not section 8
  How many dwelling units?  *Required	*Enter 1 or greater
  Are units alpha or numerical?  *Required	Choose one: Alpha (A, B, C, etc.) Numeric (Apt 1, 17 1/2, etc)

        ANNUAL FEES:  $10.00 per rental dwelling unit. (Please do NOT send cash through the mail.)

• LEGAL RENTAL PROPERTY OWNER: (Post office box does not suffice as an address)

  Name: *Required
  Street Address: *Required
  City: *Required
  State/Zip:*Required
  Home Phone*Required
  Cell Phone
  Fax
  E-mail

• LOCAL REPRESENTATIVE

• Name: *Required
  Address: *Required
  Phone: *Required
  Fax:
  Cell Phone

• CONTRACT BUYER - Please furnish copy of purchase contract

 By submitting this form I certify that:

1. The data submitted in this rental property application is an accurate representation of the facts on the date of the application;

2. I understand that the submission of this application and payment of and required fee does not constitute official registration until compliance with all the provisions of the Property Maintenance Code have been verified through all required inspections by authorized personnel and a Certificate of Registration has been issued by the City of Danville Public Development Department.

I have read the application and hereby accept the terms as stated above. (Form will not be accepted unless checked)

Today's date: mm/dd/yyyy