EmailMe Form - Jermyn Borough Affidavit for Non-Rental Unit

Name *
First Last
Date *
MM / DD / YYYY
Phone *
### - ### - ####
Email
Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Rental Address
Total # of Rental Units *
# of Units Not Rented *
Property Owner or Agent Must Update Rental Unit Permit When Unit(s) Rented, Under Penalties Listed in Ordinance #3-02 and Reolution #10-2016
Property Is: *
Vacant *
Owner-Occupied
Converted to Single Unit & Owner Occupied (Rare)
*Reason for Vacancy
Based Upon This Statement, the Borough Has Agreed to Remove the Property from the Rental Unit Listing. I Agree to Notify the Borough, in the Future, of Rental of Said Unit(s), Under the Penalties for Violation of Failure to Comply Noted in Ordinance 3-02 and Resolution #10-2016. *
I Agree