Landlord Registration Form for Multiple Unit Buildings


Property Address:  __________________________________________________


Town of Kingston Tax Map Section, Block, and Lot Number:


                              Section:  ____________________________


                              Block:  _____________________________


                              Lot Number:  ________________________


Name of Property Owner:  ____________________________________________


Owner’s Mailing Address:


                              Street:  _____________________________________________


                              City  _____________________State:  __________Zip:  ______


    Owner’s Phone Number:  ____________________________________________


If ownership is held in a non-individual capacity, list below the names, titles, addresses, and phone numbers of any responsible persons of a corporation, LLC, partnership, or other similar business entity:







Local responsible person as defined in Section XXX-2:


                              Name:  __________________________________________________


                              Address:  ________________________________________________


                              Phone Number:  ___________________________________________


I certify that all information contained in this statement is true and correct to the best of my knowledge and belief.  I understand that the willful making of any false statement of material fact herein will subject me to the provisions of law relevant to the making and filing of false instruments and shall constitute a violation of this chapter.  I understand that it is the responsibility of the owner to timely notify the Building Department whenever this information becomes outdated or for any reason is no longer accurate.  The owner is also responsible to recertify this information annually.


Signature of owner or owner’s designee:  ______________________________________

                                                                                          (If designee, give title)


Signature and stamp of a notary public:  _______________________________________