Tenant Identification Form Pursuant to Ordinance #68, landlords are required to list all rental or rentable units and tenants thereof. This ordinance is to provide for the uniform and equitable distribution of the tax levies in the township. PLEASE COMPLETE AND RETURN WITHIN FIFTEEN (15) DAYS. FAILURE TO RETURN THIS FORM OR OTHERWISE COMPLY WITH ORDINANCE #68 WILL RESULT IN A MINIMUM FINE OF $600

Owner Name *

Prefix

First *

Last *

Suffix

MI

Middle

Owners Mailing Address *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Address of Leased Premises *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Phone *

### - ### - ####

Email *

Tax Map Parcel Number *

Please enter your TMP number. This number can be found on your annual tax bills.

Please give a brief description of unit(s) *

Current Tenants Unit 1 *

*QFM units only* Relationship to landlord

Unit 2

Relationship to landlord

Unit 3

Relationship to landlord

By entering my name below I certify this information to be true and correct *

Prefix

First *

Last *

Suffix

MI

Middle

Date *

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