Account Number * Property Owner's Name * Property Address * Property Owner's Phone Number * Property Owner's Email Address * Date Property was Vacated Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Previous Tenant's Name Date Occupied by New Tenant Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 New Tenants Name - all occupants over 18 years of age Number of children under 18 living at this address * Landlord/Owner Name Completing Form * Leave this field blank
