1

License Information:

 *

Marion License No.:

2

Licensee Information:

 *

Licensee Information:

Business Name:

Mailing Address:

Mailing City, State & Zip:

3

Landlord Information:

 *

Landlord Information:

Landlord Name:

Landlord Address:

Landlord City, State & Zip:

Landlord Cell Phone:ext.

Landlord Home Phone:ext.

Landlord Office Phone:ext.

Landlord Email:

4

Management Company Information:

Per Housing Inspection Plan of Inspection, Section V, Paragraph 2 states "All out of state property owners must have a property manager within fifty (50) miles of the city of Marion."

Please select below if property is managed by the owner/landlord listed above or a management company. (NOTE: If a management company is selected, all communication will go to the management company.)

 *

Management Company Information: Per Housing Inspection Plan of Inspection, Section V, Paragraph 2 states "All out of state property owners must have a property manager within fifty (50) miles of the city of Marion." Please select below if property is managed by the owner/landlord listed above or a management company. (NOTE: If a management company is selected, all communication will go to the management company.)

Managed By Owner

Managed by Management Company (All communication will be sent to management company)

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