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Butler Rental CCO (Rental of Property)

* Fields in red are required

Borough of Butler CCO Application for Rentals
 

Names and Relationship of ALL Occupants living in the rental. (Other than tenant Listed Above):

Certification of Compliance and Working Order

Smoke/Carbon Monoxide Detectors and Fire Extinguishers must be in proper working order. By affixing your name (below) you certify that these items are in good working order and complaint with all codes and laws. If any statement within this form is willfully false, you are subject to punishment.

Download Rental Housing Regulations Overview Here

The checking of these items indicate that they are installed and are in good / proper working order.

Must be Affirmed and Signed by Landlord or Representative below

Payer Information

Payment Information

Enter information as it appears on your check (USA Banks Only)
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Using the following lower portion of a personal check as an example, enter the information that appears at the bottom of your check. Do NOT include any dashes or spaces.

Terms & Conditions:

 

I affirm that I have completed the statements listed within this form and the information given is full and true and known to be so.

Smoke/Carbon Monoxide Detectors and Fire Extinguishers must be in proper working order. By completing this form you certify that these items are in good working order and complaint with all codes and laws. If any statement within this form is willfully false, you are subject to punishment.

I agree to the above Terms and Conditions.

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