Newport Borough Landlord Form

BOROUGH OF NEWPORT Rental Property Occupancy Report

Landlord Information

Name:(Required)

First Last

Telephone #(Required)

Management Co. (if applicable)

Management Co. Telephone #

Landlord's Mailing Address(Required)

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

Email Address:(Required)

Management Company Mailing Address:

Management Company Email Address:

Rental Property Information

Address of Rental Property:

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

Unit # (If applicable):

Name(s) of all Occupants over the age of 18

Number of Occupants under the age of 18

Telephone #

Email Address

The Newport Borough office must be advised within 10 days of any changes in Tenant status. Annual reporting will be due by January 31st of each year. Landlord / Mgt Co Signature *** This form may be filed by mail, fax, e-mail or online submittal. Website: https://www.newportboro.com/information/formsandapplications/occupancyreport/ Fax: 717.567.3754 E-mail: CodeEnforcment@NewportBoro.Com Mail To: Attn: Code Enforcement 231 Market St. Newport PA 17074

LANDLORD SIGNATURE/DATE REQUIRED

Landlord / Mgt Co Signature:(Required)

Date(Required)

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