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Rental & Student Home Registration Form

  1. BuildingandHousing Header

  2. for all correspondences Name, Mailing Address, City, State Zip Code

  3. If you do not have a home number, place your mobile number here.

  4. Required if owner lives outside a 5-mile radius of the Borough of West Chester.

  5. for all correspondences Name, Mailing Address, City, State Zip Code

  6. If you do not have a home number, place your mobile number here.

  7. 3. Single Family, Two Family Dwelling or Apartments

  8. Rooming House Use Only:

  9. 4. Type of Premises

    check one

  10. 5. Do you currently have students* as tenants?

  11. example: Number of dwelling units: ______ Unit #’s: _____/____/____/____/____/____/____/____/

  12. 6. Do you have an automatic fire alarm system?

  13. 7 through 10

  14. Print Name (by printing name I certify this application)

  15. Print Name (by printing name I certify this application)

  16. bottom line

  17. Leave This Blank:

  18. This field is not part of the form submission.