1368 Research Park Drive PLANNING & ZONING DEPARTMENT Phone: (937) 427-5512
Beavercreek, Ohio 45432 Fax: (937) 427-5544
CITY OF BEAVERCREEK
ABANDONED FORECLOSURE & VACANT PROPERTY REGISTRATION
Registration Category: Abandoned Foreclosure Vacant Property
Registration Type: Initial Registration
Renewal Information Update
PROPERTY LOCATION
ADDRESS: ___________________________________________________________ ZIP CODE: ____________
PARCEL ID: B42000 ___ 00 ___ ___ 00 ___ ___ ___ 00
FORECLOSING ENTITY/ VACANT PROPERTY OWNER INFORMATION
CONTACT NAME: _____________________________________________________________________________
COMPANY NAME (IF BUSINESS): _________________________________________________________________
ADDRESS: _______________________________________ CITY: _______________________ STATE: _________ ZIP CODE: ____________
PHONE: ___________________________________ E-MAIL: _______________________________________________________________
AUTHORIZED AGENT INFORMATION
AUTHORIZED AGENT NAME: ____________________________________________________________________
COMPANY NAME (IF BUSINESS): _________________________________________________________________
ADDRESS: _______________________________________ CITY: _______________________ STATE: _________ ZIP CODE: ____________
PHONE: ___________________________________ E-MAIL: _______________________________________________________________
PROPERTY MAINTENANCE INFORMATION
CONTACT NAME: _____________________________________________________________________________
COMPANY NAME (IF BUSINESS): _________________________________________________________________
ADDRESS: _______________________________________ CITY: _______________________ STATE: _________ ZIP CODE: ____________
PHONE: ___________________________________ E-MAIL: _______________________________________________________________
PROPERTY TYPE: Single Family
Multi-family: # of Units: ______ Commercial /Industrial Vacant Parcel
Is the property secured? Yes No
UTILITIES:
Water: On Disconnected
N/A Electricity: On
Disconnnected Gas: On Disconnected N/A
Winterized: Yes No
I affirm that all the information submitted is true and correct to the best to my knowledge. I authorize city employees and others designated by the city
to enter upon the property for the purpose of ensuring compliance of the property. I further acknowledge that an inspection is required to be
scheduled and conducted with the Code Enforcement Officer. I understand that any violation(s) found on this property may be subject to criminal
action, civil action, abatement or any other legal remedy available to the City. I hereby certify that I have the legal authority to submit this registration
on behalf of the owner or foreclosing entity.
___________________________________________________________
Signature Date
_________________________________________
Printed Name
OFFICE USE ONLY
Registration #: ____________________
Date Received: ____________________
Amount Paid: ____________________
Inspection Date/Time: ____________________
Make checks payable to the City of Beavercreek. Mail the form with the check to the City of Beavercreek Planning & Zoning Department.
