Landlord Occupancy Report Mail-In Form

Butler City Building: 140 West North Street Butler, PA, 16001-5298

Phone: (724) 285-4124 Fax: (724) 285-6880 Emergency: Call 9-1-1

Landlord Occupancy Report Mail-In Form

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www.cityofbutler.org

CITY OF BUTLER

Occupancy Report

Owner's Report of Current and Departing Residents

This report may be filled out online, then printed and submitted by any method listed below.

Please return completed form to Butler City Treasurer via email, fax, mail or personal delivery:

Address:

140 W. North Street
Butler, PA 16001

Fax:

724-431-2125

Email(s):

citytreasurer@cityofbutler.org

INITIAL OCCUPANCY REPORT IS DUE WITHIN 30 DAYS OF RECEIPT

AND within 30 days of any occupant changes throughout the remainder of the year.

The following information is required for each residential property owned.

Other report formats, including emails, will be accepted only if they contain all information requested below. If section does not apply, please enter "N/A", "Unoccupied", etc.

Complete All Sections 1 thru 5 below

Section 1

Date of report

Section 2

Property information:

Address*

Street Address City State ZIP Code

Parcel # :*

List number of Units

Residential

Business / Commercial

(List ONLY RESIDENTIAL tenants below.)

Section 3

Owner information:

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

BPT #*

Phone*

Email*

Section 4

List current residential tenants age 18 +, including those who do not pay rent.*

(Do not list business/commercial tenants or their employees.)

Section 5

Please provide the following information for departing residents:

Name

Date moved

Forwarding address

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