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2. Address of dwelling containing 4 or more units*
4. How many total units at this address?*
5. How many of these units are currently occupied?*
7. What is the total sq footage designed for living and sleeping purposes with each rental unit?
9. What are the individual addresses of these rental units?*

   Example Units 1 -5 or A-G, or list Apt. 101, 201, 301, etc. 

11. Property Owner Name*
12. Property Owner Email Address*
14. Property Owner Address*
16. Property Owner City*
17. Property Owner State*
18. Property Owner Zip Code*
20. Property Owner Phone Number*
21. Is this a good 24 hour Emergency Contact Number?*

    1. Yes
    2. No
22. 24 Hour Emergency Contact Number
24. Is there an additional Property Owner?

    1. No, I am the sole owner.
    2. Yes
26. 2nd Property Owner Name
27. 2nd Property Owner Email Address
29. 2nd Property Owner Address
31. 2nd Property Owner City
32. 2nd Property Owner State
33. 2nd Property Owner Zip Code
35. 2nd Property Owner Phone Number
37. Are there additional owners?

    1. No, only the two listed.
    2. Yes
39. Upload a complete list of all owners with their names, addresses, emails, and contact phone numbers.
41. Does this Unit have an Agent or Representative for the Owner?

    1. No, residents deal with the owner.
    2. Yes
43. Agent/Representative Name
45. Agent/Representative Contact Number
46. Agent/Representative Contact Email

50. The online application is not complete until you hit the submit button below. Once you hit submit, a confirmation page will pop up confirming your submission and you will have the option to submit your $25.00 per unit  registration fee on-line through our ePay website link or in person at Village Hall located at 1 N. Prospect Avenue. Registration Payments are due by January 1st. annually. 

    
    

    A $5.00 late fee will be assessed for each month or portion thereof, where the application and fee have not been submitted to the Village.

Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field