Resident Questionnaire Form - City Of Monroe printable pdf download

Resident Questionnaire Form - City Of Monroe

CITY OF MONROE

RESIDENT QUESTIONNAIRE

P.O. BOX 629

MONROE, OHIO 45050

513-539-7374

NAME __________________________________________ SOCIAL SECURITY # _______________

SPOUSE ________________________________________ SOCIAL SECURITY # _______________

ADDRESS ___________________________________________________________________________

_________________________________________________PHONE ____________________________

DO YOU OWN THE PROPERTY IN WHICH YOU LIVE?

YES

IF NO, ARE YOU RENTING?

YES

NO - DATE MOVED INTO MONROE ______________

IF YES, NAME AND ADDRESS OF LANDLORD__________________________________________

____________________________________________________________________________________

DO YOU OWN RENTAL PROPERTY IN MONROE?

YES

IF YES, LIST TYPE OF PROPERTY (SINGLE, DUPLEX, ETC.) AND ADDRESS ________________

_____________________________________________________________________________________

DO YOU OWN RENTAL PROPERTY OUTSIDE OF MONROE?

YES

IF YES, LIST ADDRESS OF RENTAL PROPERTY OUTSIDE OF MONROE ____________________

_____________________________________________________________________________________

NAME OF EMPLOYER ________________________________________________________________

ADDRESS OF EMPLOYER _____________________________________________________________

IS TAX WITHHELD BY EMPLOYER?

YES

NO - IF YES, WHICH CITY? ________________

OTHER HOUSEHOLD MEMBERS

PLEASE LIST ALL MEMBERS (ADULT/CHILDREN) LIVING IN YOUR RESIDENCE

NAME

AGE (MINORS)

SOCIAL SECURITY #

EMPLOYER NAME

_____________________________________________________________________________________

I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.

_______________________________________________________________ ________________________________________________

SIGNATURE

DATE

Resident Questionnaire Form - City Of Monroe