Landlord Report Form


Landlord Report Form Fillable PDF

Millersburg Borough Ordinance No. 2-05 requires that all landlord/property owners who lease/rent any property within the Borough of Millersburg provide to the Borough the address of such rental or leased property and the names and other information as required on this form of the tenants of such rented or leased units. All reports required under Ordinance No. 2-05 shall be made within ten (10) days of a change of occupancy, including a vacancy.Print N/A if section(s) 3, 4, or 5 is/are not applicable.

The information requested must be provided in full or the form will not be accepted. Any individual living at this address not listed on this form constitutes a violation of Ordinance No. 2-05 and the landlord/owner may be prosecuted.

This information will be shared with the Millersburg School District Business Office and the Millersburg Borough Police Department.

Earlier versions of this form will not be accepted.

Millersburg Borough
Landlord Report Form
Revised 4.19.2018