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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.