City of Fairfield
LANDLORD TENANT REPORT
Landlord Name: ______________________ Address:_______________________________ Phone Number _______________
Complete a form for each rental property located within the City of Fairfield and email, fax or remit to the address listed below within
thirty (30) days of the tenant move in or out date. If tenant is moving out, provide a forwarding address when available.
Full Name of Tenant Complete/Forwarding Address (including Apt #) Date In Date Out Phone Number
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________
_________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
__________________________________ ______________________________________ _________ _________ ____________
If additional forms are needed, contact our office at the number listed below or visit our web site at www.fairfield-city.org.
INCOME TAX DIVISION
EMail - income.tax@fairfield-city.org
Fax - (513) 867-5333
701 Wessel Drive, Fairfield, Ohio 45014 513-867-5327