North irwin borough



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NORTH IRWIN BOROUGH

Rental Registration/s



*Date:
*Property Owner/s:
*Address:

*Phone Number:
Fax Number:
*Email Address:



Name of Tenant

Address

*Tax Map


Number

Date tenant moved in/out

(Mark X on in or out)


Number of
occupants






27-01-












27-01-












27-01-












27-01-












27-01-









I hereby certify that the statement contained herein is true and correct to the best of my knowledge and belief. I understand if I knowingly make any false statements herein, I am subject to such penalties as may be presented by law or ordinance.



_________________________________

Property Owner’s Signature/s

Received by:

Borough Secretary/Treasurer

Mail or Drop off at:

Town Hall

21 2nd Street

North Irwin, Pa 15642


Fax to: 724-863-7904

*information must be provided


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