CITY OF MADERA
Neighborhood Revitalization Department
REGISTRATION FORM FOR VACANT BUILDINGS
Registered Address: ___________________________________________________________
Assessor Parcel Number: _______________________________________________________
For Office use Only
Date Rec’d________
Rec’d by___________
Please fill out the information requested below pursuant to Madera Municipal Code Section
9-12.01 and deliver this form to the City of Madera Neighborhood Revitalization
Department either in person or mail to : 330 South C Street, Madera, CA 93638
Property Owner:______________________________________________________________
Contact:____________________________________________________________________
Alternate Contact Phone Number: _______________________________________________
Mailing Address: __________________________________ Apt./Suite: _________________
City:
_______________________ State: _____________ Zip: ____________________
Standard Annual Fee of $550.00 Please Check One: New Registration Renewal
Please make all payments by check or money order. Include the address of the property
you registering on your check or money order.
An Annual registration fee shall accompany this registration form. The fee and registration is
valid for one (1) year from the date of registration. You are required to renew your registration
every year that your property is vacant. Registration fees will be not be prorated. You will be
notified when your registration has expired or when renewal is required.
Initiated by:
___________________________ ______________________ _____________________
Print Name Signature Date
Neighborhood Revitalization Department, 330 South C Street, Madera, CA 93638 (559) 661-5114
REV. 9/13/2018
