2. Property Owner(s) Name:*
4. Rental Property Address:*
6. Property Type:*

   (Please indicate type)

   1. House
   2. Duplex
   3. Triplex
   4. Quadplex
   5. Apartment
8. Number of units:*
10. Monthly Rent:*
12. Number of months rented in past 12 months:*
14. Expenses:*

    (Please indicate type, monthly cost and/or if renter paid)

    1. Gas
    2. Power
    3. Water/Sewer
    4. Garbage
    5. Internet/Satellite
    6. Television
    7. Other
16. Cost for gas:*
17. Cost for power:*
18. Cost for water/sewer:*
20. Cost for garbage:*
21. Cost for internet/satellite:*
22. Cost for television:*
24. Other-please explain:*
26. Other Expenses:*

    (Please indicate type, annual cost and/or if renter paid)

    1. Taxes
    2. Insurance
    3. Management
    4. Landscaping
    5. Maintenance
28. Cost for taxes:*
29. Cost for insurance:*
31. Cost for management:*
32. Cost for landscaping:*
33. Cost for maintenance:*
37. Internal Use Only:
39. Parcel #: _________________________
40. Code Area: __________
41. Class: __________
43. Bed/Bath: __________
44. Low Income: __________
45. Sec 42: __________
46. Elderly Housing: __________
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51. Email address

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