Occupancy Permit Application

# OF OCCUPANTS *

ARE YOU RENTING, LEASING OR PURCHASING? *

• RENTING
• LEASING
• PURCHASING

DATE MOVING IN: *

ADDRESS OF PROPERTY OR RENTAL UNIT: *

CURRENT PHONE NUMBER *

HEAD OF HOUSEHOLD: *

First

Last

DATE OF BIRTH: *

LAST 4 OF SSN: *

DRIVER'S LICENSE #: *

PLACE OF EMPLOYMENT: *

EMPLOYER'S PHONE #: *

EMPLOYER'S ADDRESS: *

OTHER OCCUPANT #1:

First

Last

RELATIONSHIP:

DATE OF BIRTH:

LAST 4 OF SSN:

OTHER OCCUPANT #2:

First

Last

RELATIONSHIP:

DATE OF BIRTH:

LAST 4 OF SSN:

OTHER OCCUPANT #3:

First

Last

RELATIONSHIP:

DATE OF BIRTH:

LAST 4 OF SSN:

NAME OF PROPERTY OWNER/LANDLORD (IF RENTING):

First

Last

Submit

NOTE #1: Birth Certificates and notarized Guardianship papers are required for all occupants who do not have the same surnames or are claiming relationship to the family. “It Is Illegal For More Than The Official Number of Occupants To Reside in the Address Noted Above.” To remove a spouse, a divorce Decree or death certificate is required.

NOTE #2: CHANGE OF OCCUPANTS – If the Head of Household is out of town, head of household must send Northwoods a WRITTEN and NOTARIZED request to ADD or DELETE occupant(s) by name. Head of Household name and photo ID must be included in the request and name must match current head of household name on file. Additional occupants must not exceed the total # of allowed occupants.