BOROUGH
OF STROUDSBURG
700
Sarah Street
Phone
(570) 421-5444, Fax (570) 421-2690
Go
to the above website and download extra forms.
Please type or print clearly. Complete
every January and within
30 days of a change in tenant occupancy.
Rental Property Information
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Rental
Property Address: |
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Apartment Number: |
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Has this address changed due to the 9-1-1
Re-Addressing Project? If so, please indicate prior address. |
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Tenant Information
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Tenant #1 (Adult Tenants
Only)
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Name |
Date
Tenant Moved In: |
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Employer
Name |
Employer
City/State |
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Name
of Previous Tenant: |
Date
Prior Tenant Moved Out: |
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Tenant #2 (Adult Tenants
Only)
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Name |
Date
Tenant Moved In: |
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Employer
Name |
Employer
City/State |
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Name
of Previous Tenant: |
Date
Prior Tenant Moved Out: |
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Tenant #3 (Adult Tenants
Only)
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Name |
Date
Tenant Moved In: |
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Employer
Name |
Employer
City/State |
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Name
of Previous Tenant: |
Date
Prior Tenant Moved Out: |
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Tenant #4 (Adult Tenants
Only)
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Name |
Date
Tenant Moved In: |
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Employer
Name |
Employer
City/State |
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Name
of Previous Tenant: |
Date
Prior Tenant Moved Out: |
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Property Manager Information
*All
property owners who are not FULL-TIME residents of Monroe County must
designate a property manager who does reside within Monroe County. |
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Name: |
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Phone Number: |
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E-Mail: |
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Property Owner Information
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Name: |
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Mailing Address: |
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Phone Number: |
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E-mail: |
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Signature
of Property Owner:
Date: |
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