The following information is what you will need to bring when registering and a copy of the proof, (Tax bill, lease agreement, current month's PPL bill with physical address are acceptable) must be submitted at the time of registration:
Name of Property Owner _____________________________________________
Permanent Mailing Address _____________________________________________
City ______________________________ State ___ Zip ______________
Local Phone Number ______________ Tax ID Number ______________
Lot/Block/Section ______________ Subdivision ______________
| Name of Immediate Family Members (who reside with applicant) |
Relationship To Applicant |
In Case of Emergency Notify:
| Name |
| Address |
| City State Zip |
| Phone |
Signature of Applicant ___________________________ Date _____________
For Official Use Only
Proof of residency supplied
(Tax Bill / Lease Agreement) ___________________________
Driver's License Number _______________________
Name of Property Owner ___________________________
Mailing Address _____________________________________________
City ______________________________ State ___ Zip ______________
Amount Paid ______ Check Number ______ Cash Receipt ______
Phone Number: ___________________________
Badge Number (S) Issued ______ Date __________