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2. New or Renewal?*

   1. New

   1. Renewal
3. License number if Renewal
5. Address of Rental Property*
7. City*
8. State*
9. Zip Code*
11. Number of Bedrooms*
12. Number of Occupants/Tenants*
16. Legal Owner Information:
18. Name*
19. Date of Birth*
    Date of Birth
20. Driver's License No.*
22. Billing Address (No P.O. Box Numbers)*
24. City*
25. State*
26. Zip Code*
28. Cell Phone Number*
29. Work Phone Number
31. Home Phone Number
32. Email Address*
34. Note:

    if in land trust, list name and addresses of each beneficiary on this space

38. Please Check One*

    1. Emergency Contact

    1. Managing Agent
40. Name
41. Date of Birth
    Date of Birth
42. Driver's License No.
44. Address
46. City
47. State
48. Zip Code
50. Cell Phone Number
51. Work Phone Number
53. Home Phone Number
54. Email Address
56. Note:

    If the Owner is not a Hanover Park resident, a Managing Agent is required to accept service for all purposes and authority over the property, including its maintenance.

60. Tenant Information
62. Name
63. Cell Phone Number
64. Home Phone Number
68. Owner Attestation

    I, the undersigned, do hereby certify under penalty of perjury that:

    1. I have read and understand Chapter 82 Rental Residential Housing Codes of the Hanover Park Municipal Code. (Available at hpil.org or at the Hanover Park Village Hall.)

    2. Except where indicated by (*), information on this form is not subject to public release pursuant to the Freedom of Information Act.

    3. Rental Residential Inspection Fees. Your license is not valid until all fees are paid.

    - $100 for two-year license. This includes the first inspection

    - $75 for a failed inspection, payable within 30 days.

    - $75 for a second or subsequent inspection, payable prior to the inspection.

    - $25 will be charged with interest at 6% for failing to pay any inspection fee within 30 days of that inspection.

    - $100 will be charged for failure to attend an inspection or for cancelling a scheduled inspection with less than 24 hours' notice, payable prior to the issuance of the license. One rescheduling is allowed each license year if 24 hour's notice is given.

    4. If there is no managing agent, service by regular mail upon the Owner at the address stated in this Application will be sufficient service for all purposes.

    5. The information in this Application is true and correct.

70. Owner Signature*

    DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

71. Date*
    Date
73. Owner Signature

    DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

    
    

74. Date
    Date
78. Note:

    on April 18th, 2013, the Village Board of Hanover Park approved the Crime Free Multi-Housing Program. This program requires a landlord to attend an educational training seminar.

80. Within the last year, have you attended a training seminar at Hanover Park or another jurisdiction?*

    1. Yes
    2. No
Leave This Blank:


82. 1. Receive an email copy of this form.
83. Email address

    This field is not part of the form submission.

84. Submit

* indicates a required field