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2. 
4. Tenant & Landlord Information Form
5. Rental Type
   -- Select One --EXISTINGNEW

   choose one
7. Address of Rental Property*
8. Owner Name*
9. Owner Phone Number*
11. Owner's Mailing Adress*
12. Owner's Email Address*
13. Number of Rooming Units*
14. Number of Dwelling Units*
16. A separate Occupancy Report must be completed for each rental property. Tenant list must be supplemented within (15) days of arrival of tenants not previously reported. Please complete and submit this form to Building & Housing Department, 401 E. Gay St. West Chester, PA 19380.
20. Please read Borough Ordinances below:
22. Trash Collection, Chapter 62 – Accumulation of storage of garbage waste, refuse, rubbish or recyclables shall be contained in 35-gallon cans with tight-fitting lids.
24. Grass & Weeds Control, Chapter 41 – Any grass, weeds or other vegetation growing in excess of 10” shall be considered to be a public nuisance.
26. Snow & Ice Removal, Chapter 95 – Within 6 hours of ice appearing on a sidewalk, but before it can be removed as provided herein, a nonskid material, such as rock salt, cinders, etc. shall be applied to the sidewalks. Within a period of 24 hours after cessation of snowfall or other precipitation, sidewalks hall be cleared, and a nonskid material applied to the sidewalk.
28. Limits to Number of People, Chapter 112 – I (we) understand the Borough Ordinance sets limits to the number of residents residing in a dwelling unit; I (we) understand that the Landlord/Tenants face a maximum fine of $500.00/day plus court cost and attorney fees if found liable for a violation of the maximum number of occupants.
32. Rental Occupancy Report
34. Date Completed:*
    Date Completed:

36. Note: You may attach a computer-generated list using Excel or Word formatting. It must contain all the required information. In addition, forms are available on our website west-chester.com under Government, Building and Housing, Forms. You may email your report to rentals@west-chester.com or fax 610-692-7958. Any questions please contact Wendy Mecke at 610-696-1773.

38. Instructions: Please list unit numbers of every rental unit whether the unit was occupied or vacant. Please provide first and last names of each current tenant who is (18) years or older and who resides in the specific unit. If the tenant is a student, you must indicate that individual is taking 6 or more credit hours per semester.
40. Unit Number
41. Tenant(s) Name
    First & Last Name
42. Student

    1. Yes
    2. No
43. Credit Hours (6 or more)
    -- Select One --YesNo
45. Unit Number
46. Tenant(s) Name
    First & Last Name
47. Student

    1. Yes
    2. No
48. Credit Hours (6 or more)
    -- Select One --YesNo
50. Unit Number
51. Tenant(s) Name
    First & Last Name
52. Student

    1. Yes
    2. No
53. Credit Hours (6 or more)
    -- Select One --YesNo
55. Unit Number
56. Tenant(s) Name
    First & Last Name
57. Student

    1. Yes
    2. No
58. Credit Hours (6 or more)
    -- Select One --YesNo
60. Additional Information
    If there are additional units / tenants please attach supporting document.
Leave This Blank:


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

    This field is not part of the form submission.

64. Submit

* indicates a required field