Forms • VACANT PROPERTY REGISTRATIN REQUEST FORM

VACANT PROPERTY REGISTRATIN REQUEST FORM

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DATE*		INSPECTION DATE*
REPORTED BY*
PROPERTY ADDRESS*		BLACK JACK, MO 63033
HOUSING CODE VIOLATIONS FOUND ON THE PROPERTY*
PROPERTY OWNER NAME*
ADDRESS*
PHONE*		EMAIL*
LOCAL PROPERTY MANAGEMENT COMPANY
NAME OF CONTACT
ADDRESS
PHONE		EMAIL
SEMI-ANNUAL REGISTRATION FEE - $200

* indicates required fields.