Application for Rental Housing Registration
City of Havre de Grace
711 Pennington Avenue
Havre de Grace MD 21078
(410) 939-1800 / fax (410) 939-7632
** Please print or type **
R
ental Property Street Address: __________________________________________ Apt # ____________
NOTE: Each rental unit or individual apartment must be registered separately.
Property Tax Identifier: _________________________________
# of Bedrooms ________ # of Bathrooms ________ Efficiency ________ Rooming House ______
Year residence constructed: ______________
Property Owner(s) Name: _________________________________________________________________
Owners Address: _______________________________________________________________________
_______________________________________________________________________
Owners Phone: ___________________________________ Home / Cell / Work (circle one)
___________________________________ Home / Cell / Work (circle one)
Owners E-mail: ___________________________________
Management Company (if any) : ____________________________________________________________
Agent Name: _________________________________________ Phone: _____________________________
Address: _________________________________________________________________________________
Email: _____________________________________________
If owner and Management Company are located more than 25 miles outside the City of Havre de Grace,
please list a local person or company that may act on your behalf in case of emergency (cannot be tenant):
Name: ______________________________________________ Phone: _____________________________
Address: __________________________________________________________________________________
Email: _____________________________________________
It is the responsibility of the property owner, or their agent, to notify The City of Havre de Grace of any
change in tenant, in writing, at the time of tenant change. No registration is transferable to another person,
or to another housing unit or premises. Every property owner shall give notice in writing to The City of
Havre de Grace within 72 hours of the transfer of any legal ownership interest or control of any registered
housing unit. The notice shall include the name and address of the person succeeding to the ownership
interest or control of the housing unit.
P
roperty Owner Signature: ______________________________________________ Date: _____________
Management Company/Agent Signature: __________________________________ Date: _____________
**** ATTACH TENANT INFORMATION FORM AND LEAD PAINT COMPLIANCE FORM ****
*********
*********************************************************************************
[ For office use only ]
R
egistration Number: _______________
City of Havre de Grace – Agent Signature: ________________________________ Date: ______________
Comments:
___________________________________________________________________________________________
___________________________________________________________________________________________
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