2. Division of Rental Inspections
   333 S. Tanner St. Room 402 Rantoul, IL 61866 Office Ph:(217)892-6804 Fax:(217)892-5501
4. Property Address
6. City
7. State
8. Zip
10. Tax ID / Parcel #
11. Today's Date
13. Check all that apply:

    1. Rental
    2. For Sale

    1. Foreclosure

    1. Rehab

    1. Other
15. If "other", please describe.
17. Name(s) of Legal Owner(s)
19. Mailing Address
21. City
22. State
23. Zip
25. Contact Information
    Email or Phone
27. Property Manager
29. Mailing Address
31. City
32. State
33. Zip
35. Contact Information
    Email or Phone
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

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