Owner Officer Agent Information

RESIDENTIAL RENTAL PrOPERTY REGISTRATION Office Phone: 440-279-1600 440-285-2222 440-834-1856 440-564-7131 Ext. 1600 440-286-4359 Tracy A. Jemison, AAS Geauga County Auditor 231 Main Street, Suite 1A Chardon OH 44024 auditor@co.geauga.oh.us www.auditor.co.geauga.oh.us Office Fax: Owner/Officer/Agent Information Owner Name: _____________________________________________ Work Phone: ______________ Address: _________________________________________________ Home Phone: ______________ City: ___________________________________ State: __________________ Zip: _______________ Corporation Individual Partnership Ownership Type: Trust Information must be submitted for every owner of these properties. If owned by a corporation, an officer must be listed. Corp Officer Name: ________________________________________ Work Phone: ______________ Address: _____________________________________________________________________________ City: ___________________________________ State: __________________ Zip: _______________ An agent can be a person at least 18 years old, residing in or maintaining an office in Geauga County or any county in Ohio. Agent Name: _____________________________________________ Work Phone: ______________ Business Name: ___________________________________________ Phone: ___________________ Address: _____________________________________________________________________________ City: ___________________________________ State: __________________ Zip: _______________ Rental Properties owned in Geauga County 1. Location Address : _______________________________ City/Township/Village: ______________ Auditor Parcel Identification [ _______________________ ] Lot Number _________________________ Number of Habitable Buildings on Property _________________ Number of Dwellings Units on the Property __________________ Year Built __________ 2. Location Address : _______________________________ City/Township/Village: ______________ Auditor Parcel Identification [ _______________________ ] Lot Number _________________________ Number of Habitable Buildings on Property _________________ Number of Dwellings Units on the Property __________________ Year Built __________ 3. Location Address : _______________________________ City/Township/Village: ______________ Auditor Parcel Identification [ _______________________ ] Lot Number _________________________ Number of Habitable Buildings on Property _________________ Number of Dwellings Units on the Property __________________ Year Built __________ Owner/Applicant Signature Date American LegalNet, Inc. www.FormsWorkflow.com