Newport Borough Landlord Form

Home » Information » Forms and Applications » Landlord Form

NEWPORT BOROUGH LANDLORD REPORT FORM (SUBMISSION REQUIRED)

NOTE: Please use a separate form for each rental unit. This form may be copied or you can pick up copies at the Newport Municipal Building, 231 Market Street, Newport, PA 17074.

LANDLORD INFORMATION

Name of Landlord:(Required)

First Last

Address of Landlord:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone #:(Required)

Email Address:

Address of Rental Unit:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

FORMER TENANT (To Be Filed Within Ten Days of Arrival)

Name(s) of Former Adult Occupant(s):

Telephone #:

Forwarding Mailing Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Occupancy Terminated:

NEW TENANT INFORMATION (To Be Filed Within Ten Days of Arrival)

Name(s) of New Adult Occupant(s):(Required)

Telephone #:(Required)

Email Address:

Mailing Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Occupancy:(Required)

LANDLORD SIGNATURE/DATE REQUIRED

Signature of Landlord (Typed signature is acceptable for electronic submission):(Required)

Date(Required)

***This form may be filed by mail, fax, email, or online submittal.

Website: http://www.newportboro.com/
Fax: (717)567-3754
Email: codeenforcement@newportboro.com

Mail To:
Attn: Borough Secretary
Newport Borough
231 Market Street
Newport, PA 17074

CAPTCHA