City of Rensselaer
Building Department
City Hall, 62 Washington St.
Rensselaer, New York 12144
Phone (518) 462-5489 Fax: (518) 465-2031
Rental Dwelling Registry
Date____________
Address of Rental Property__________________________________________________
Number of Stories_________ Number of Residential Units in Building_________
Commercial Space: Floor________ Type_____________________________________
Number of Units on Each Floor: Basement_____ First______ Second______
Third________ Fourth_____ Other_______
Individual Owner Information
Owner Name_____________________________________________________________
Owner’s Mailing Address* _________________________________________________
Owner’s Physical Address* _________________________________________________
PLEASE NOTE IF MAILING ADDRESS IS A PO BOX, WE MUST HAVE A
STREET ADDRESS
Telephone Number: Home_________________ Work___________________
Cell __________________
Date of Birth_______________ Year Owner Purchased Building__________________
Additional Owner(s):
Name(s)_________________________________________________________________
Address(es)______________________________________________________________
PLEASE NOTE IF MAILING ADDRESS IS A PO BOX, WE MUST HAVE A
STREET ADDRESS
Telephone Number(s): Home_________________ Work___________________
Cell __________________
City of Rensselaer
Rental Dwelling Registry
City of Rensselaer
Rental Dwelling Registry
*If the owner does not reside within fifty miles of the property, a local agent must be
designated who can be available day or night.
Corporation Owner / Partnership, etc
.
Name of Corporation or Partnership___________________________________________
Contact Person___________________________________________________________
Address_________________________________________________________________
________________________________________________________________________
PLEASE NOTE IF MAILING ADDRESS IS A PO BOX, WE MUST HAVE A
STREET ADDRESS
Telephone Number(s): Home_________________ Work___________________
Cell __________________
Year Owner Purchased Building_____________________________________________
Designation of Local Agent
Agent Name_____________________________________________________________
Agent Address___________________________________________________________
________________________________________________________________________
________________________________________________________________________
Telephone Number(s): Home_________________ Work___________________
Cell __________________