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2. 
4. Date of Submission:*
   Date of Submission:
5. Rental Type*
   -- Select One --EXISTINGNEW

   choose one
7. 1. Address of Rental Property*
9. Name(s) of Owner(s)*
11. Owner's Mailing Address*
    for all correspondences Name, Mailing Address, City, State Zip Code
13. Home Phone Number*
    If you do not have a home number, place your mobile number here.
14. Mobile Phone Number
16. Email Address*
20. 2. Name of Responsible Agent
    Required if owner lives outside a 5-mile radius of the Borough of West Chester.
22. Responsible Agent’s Mailing Address
    for all correspondences Name, Mailing Address, City, State Zip Code
24. Home Phone Number*
    If you do not have a home number, place your mobile number here.
25. Mobile Phone Number
27. Email Address*
31. 3. Single Family, Two Family Dwelling or Apartments
33. Total Number of Dwelling Units
34. Total Number of Dwelling Units being Rented
36. Rooming House Use Only:
38. Total Number of Rooming Units
39. Total Number of Rooming Units being Rented
43. 4. Type of Premises

    check one

    1. Single Family / Two Family Dwelling
    2. Apartment House (3 or more dwellings)
    3. Rooming House
    4. Mixed Use Building (i.e, store/office with apartments)
45. 5. Do you currently have students* as tenants?

    1. YES
    2. NO
47. If yes, please provide which dwelling units are rented to students and the unit number:
    example: Number of dwelling units: ______ Unit #’s: _____/____/____/____/____/____/____/____/
49. 6. Do you have an automatic fire alarm system?

    1. YES
    2. NO
50. If YES, please provide the Central Station Company and telephone number
54. 
56. Signature of Owner(s)*
    Print Name (by printing name I certify this application)
57. Signature Responsible Agent*
    Print Name (by printing name I certify this application)
59. 
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field