This form is to be used by new Tenants of the Village of Richton Park. Please fill out form completely and print a copy and bring to the Village Hall with the following documents: Occupancy Inspection, Photo ID, Lease and Crime Free Housing Lease Addendum, and $50 Water Application Fee. Please Note: An appointment will need to be made in order to turn water on and someone must be present at the service address at the time of the appointment.

Move In/Close Date:*

First Name: *

Last Name: *

First Name:

Last Name:

Richton Park Service Address: *

Home Phone #:

Cell Phone #: *

Date of Birth: *

Date of Birth: *

Provide at least last 4 digits

Employer's Information:

Employer's Name: *

Address:

City:

State:

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Zip:

Work #:

Owner's Information:

First Name:

Last Name: *

Address: *

City:

State:

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip:

Phone #: *

Signature: Must present photo ID in person

If you would like, you may upload your lease and occupancy inspection to help save time.

Lease:

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Occupancy Inspection:

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Please make sure you also complete the "Crime Free Housing Lease Addendum"