Borough Of Pennsbury Village

1043 Pennsbury Blvd.

Pittsburgh, PA 15205

Enter information for every occupant who is/will be living in your unit. If you are done, drop down to the bottom of this page to the Certification Block.

Your Name:
Your Street Address:
Your City:
Your State:
Your Zip Code:
Your Day Phone #:
Your Evening Phone #:
Your Email Address:
Purpose:
Property Management:

Management Name:
Street Address:
City:
State:
Zip Code:
Day Phone #:
Email Address:

Management Information

House Number:
Street:
Status:
Number of Occupants:	If you chose "More Than 6" Please Contact The Borough Office
Lease Start Date:
Lease End Date:

Leaseholder Name:
Day Phone #:
Evening Phone #:
Cell Phone #:
Email Address:
Resident Status:
Resident Age Class:
Employment Status:
Employer:

Primary Leaseholder / Tenant Information

Complete this block for primary leaseholder of your property

Complete one block for each additional tenant occupying your property

Additional Occupant #A Information

Tenant Name:
Day Phone #:
Evening Phone #:
Cell Phone #:
Email Address:
Resident Age Class:
Employment Status:
Employer:

Additional Occupant #B Information

Tenant Name:
Day Phone #:
Evening Phone #:
Cell Phone #:
Email Address:
Resident Age Class:
Employment Status:
Employer:

Additional Occupant #C Information

Complete one block for each additional tenant occupying your property

Tenant Name:
Day Phone #:
Evening Phone #:
Cell Phone #:
Email Address:
Resident Age Class:
Employment Status:
Employer:

Tenant Name:
Day Phone #:
Evening Phone #:
Cell Phone #:
Email Address:
Resident Age Class:
Employment Status:
Employer:

Tenant Name:
Day Phone #:
Evening Phone #:
Cell Phone #:
Email Address:
Resident Age Class:
Employment Status:
Employer:

Additional Occupant #D Information

Complete one block for each additional tenant occupying your property

Additional Occupant #E Information

Certification

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Items in Black require an answer or form will not submit!

Enter information for every occupant who is/will be living in your unit. If you are done, drop down to the bottom of this page to the Certification Block.

New Tenant Registration Form

Landlord Information

Complete this block only if your property is managed locally by someone other than yourself

Property Information

By typing my name below and clicking Submit, I hereby certify
to the correctness of the above information I am submitting.

As the owner/landlord of the property, enter your information here.

If you have another person or company manage your rental property, enter their information here.

Enter information about your rental property and the lease dates here.

Enter information about the person who signed the lease here.

If the leaseholder is not a resident of the rental property, please select the "Does Not Reside in Pennsbury" option in the three drop-down boxes.

Enter information for every occupant who is/will be living in your unit. If you are done, drop down to the bottom of this page to the Certification Block.

(412) 279-7876

Enter your name as thought you were signing the form in person and then hit submit.

Thank you!

Warning: Clicking "Reset" will erase ALL entries on your form!

Items in Black Require an answer or form will not submit!

Items in Black require an answer or form will not submit!

Note: Items in Black require an answer or form will not submit!

Digital Signature:

Security Code:

Click Submit:

Type in the security code as it appears in the grey box.

Must Be In Caps!

Click "Submit" To Send Your Completed Form.