Residential Rental Property Disclosure Form - Cuyahoga County Fiscal Officer
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2CUYAHOGA COUNTY FISCAL OFFICER
1219 ONTARIO STREET, ROOM 315
2079 E. 9th Street 4th Floor
CLEVELAND, OH 44113-1657
Cleveland, OH 44115
TELEPHONE (216) 443-7020 • FAX (216) 698-2748
WEB ADDRESS:
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RESIDENTIAL RENTAL PROPERTY DISCLOSURE FORM
(O.R.C. 5323.02 and 5323.99)
1. Owner(s) Name:_________________________________________________________
Street __________________________________________________________________
City___________________________________________State________ Zip________________
Phone No. ____________________________
2. If the property is owned by a trust, business trust, estate, partnership, limited partnership, LLC,
association, corporation, or any other business entity, please disclose the name of the Trustee, executor,
general partner, member, manager, associate, or officer, whichever applies:
Name ______________________________________ Title ____________________
3. Address of Residential Rental Property:
Street ___________________________________________________________________
City ____________________________________ State________ Zip________________
Permanent Parcel No. _______________________
4. Are the dwelling units currently leased?
Yes ____
No ____
What year were the dwelling units built?
Year _______.
NONRESIDENT OWNERS DISCLOSURE OF AGENT
(O.R.C. 5323.03 and 5323.99)
Name of Ohio Agent: ___________________________________________________
Street _______________________________________________________________
City ____________________________________State ________ Zip _____________
Phone No. ____________________________
Signature ______________________________________________
FOR CO UNTY U SE ON LY
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