Rental Housing Registration
Tenant Information
** Please print or type **
Registration Number: ____________________
Rental Property Street Address:
_______________________________________________________ Apt # _____________
Please list all occupants for this property:
Lessee Name: __________________________________________________________
__________________________________________________________
Date of move-in: __________________________
Other occupants:
Name Relation to Lessee
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
By signing below, lessee and owner, or their Managing Agent, verify the rental unit has been
inspected for any property defects. Noted deficiencies and any required repairs have been agreed
to in writing.
Lessee Signature: ____________________________________________ Date: _____________
Owner / Agent Signature: ______________________________________ Date: _____________
Return signed form to: City of Havre de Grace
711 Pennington Avenue
Havre de Grace MD 21078
Owner / Agent sign here if rental unit is currently vacant:
________________________________________________ Date: __________________
Vacant as of: ______________________ (complete new form when occupied)
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