Borough Of Pennsbury Village

1043 Pennsbury Blvd.

 
 Your Name:  
 Your Street Address:  
 Your City:  
 Your State:  
 Your Zip Code:  
 Your Day Phone #:  
 Your Evening Phone #:  
 Your Email Address:  
 Report Reason:  
 House Number:  
 Street:  
 Number of Occupants:     If there were more that 6 occupants, please call the Borough Office
 Vacancy Start Date:                                        
 Leaseholder Name:  
 New Street Address:  
 New City:  
 New State:  
 New Zip Code:  
 New Day Phone #:  
 New Evening Phone #:  
 Cell Phone #:  
 Email Address:  
 Residency Status:  
   

 

  Occupant #A Forwarding Information
 Tenant Name:
 Forwarding Status:
 New Street Address:
 New City:
 New State:
 New Zip Code:
 New Day Phone #:
 New Evening Phone #:
 Cell Phone #:
 Email Address:
   

 

  Occupant #B Forwarding Information
 Tenant Name:
 Forwarding Status:
 New Street Address:
 New City:
 New State:
 New Zip Code:
 New Day Phone #:
 New Evening Phone #:
 Cell Phone #:
 Email Address:
   

 

  Occupant #C Forwarding Information
 Tenant Name:
 Forwarding Status:
 New Street Address:
 New City:
 New State
 New Zip Code:
 New Day Phone #:
 New Evening Phone #:
 Cell Phone #:
 Email Address:
   

 

  Occupant #D Forwarding Information
 Tenant Name:
 Forwarding Status:
 New Street Address:
 New City:
 New State:
 New Zip Code:
 New Day Phone #:
 New Evening Phone #:
 Cell Phone #:
 Email Address:
    

 

  Occupant #E Forwarding Information
 Tenant Name:
 Forwarding Status:
 New Street Address:
 New City:
 New State:
 New Zip Code:
 New Day Phone #:
 New Evening Phone #:
 Cell Phone #:
 Email Address:
Leaseholder and Tenant Forwarding Information



  
Digital Signature:




       Security Code:



          Click Submit:
 

   

 

          

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

                                                                   

 

                                                       

 

 

Certification
   

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Pittsburgh, PA 15205

Tenant Vacancy Notification Form

Property Information
Landlord 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.

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

(412) 279-7876

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


Thank you!

Warning:   Clicking on Reset will erase all entries on your form!

Back

Enter forwarding information about your ex-leaseholder / tenant here.  Information titles in black require answers.  Continue to the next block to enter the next ex- occupant.  If there are no more occupants to enter, drop down to the Certification block.

Enter forwarding information about your each additional tenant here.  If the forwarding information is the same, enter the name and pick that option in the pull-down box.  Then go on to the next occupant.  If there are no more tenants to enter, drop down to the bottom of the page.  Enter your name as a digital signature and click on submit.

Enter forwarding information about your each additional tenant here.  If the forwarding information is the same, enter the name and pick that option in the pull-down box.  Then go on to the next occupant.  If there are no more tenants to enter, drop down to the bottom of the page.  Enter your name as a digital signature and click on submit.

Enter forwarding information about your each additional tenant here.  If the forwarding information is the same, enter the name and pick that option in the pull-down box.  Then go on to the next occupant.  If there are no more tenants to enter, drop down to the bottom of the page.  Enter your name as a digital signature and click on submit.

Enter forwarding information about your each additional tenant here.  If the forwarding information is the same, enter the name and pick that option in the pull-down box.  Then go on to the next occupant.  If there are no more tenants to enter, drop down to the bottom of the page.  Enter your name as a digital signature and click on submit.

Back

Enter forwarding information about your each additional tenant here.  If the forwarding information is the same, enter the name and pick that option in the pull-down box.  Then go on to the next occupant.  If there are no more tenants to enter, drop down to the bottom of the page.  Enter your name as a digital signature and click on submit.

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

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

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!

Must Be In Caps!

 Click Submit To Send Your Completed Form.