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2. Registration of Vacant Properties & Properties in Default

   Pursuant to Ordinance 16-06-04 of the Municipal Code, any residential building that has been determined to be a “Registrable Property” must be registered with the Village of Round Lake Beach. Within 21 calendar days of the date of the Notice of Determination, please submit this completed form an inspection needs to take place no later than 60 days of the Notice of Determination. A separate registration form and fee must be submitted for each Registrable Property. Any changes to the information contained on this form must be reported to the Village within 10 calendar days. 

4. Today's Date
6. Date of Notice:
8. Registrable Property:
10. Type of Registration

    1. New Registration

    1. Renewal Registration

    1. Amended Registration
12. Occupancy Status

    1. Occupied
    2. Vacant
14. Plan of Action

    Describe plan of action and timeline to (a) Remove unsightly boarding and secure from unlawful entry, where applicable, (b) Meet and maintain all property standards and codes, (c) Occupy property or intent for extended vacancy, (d) Intent to rehab, demolish, sell and/or rent, where applicable. Attach additional sheets if necessary. 

16. Unboard & /or Secure
17. Estimated Completed by
18. Details
20. Bring Up to Code
21. Estimated Completed By
22. Details
24. Ongoing Maintenance
25. Estimated Completed by
26. Details
28. Plan for Occupancy
29. Estimated Completed by
30. Details
32. Plan for Property (Demo/Sale/Rent
33. Estimated Completed by
34. Details
36. Other Comments
38. Contact Information

    Street addresses required; post office boxes not acceptable. Owner may choose to identify an agent that is authorized to accept service and receive notices and/or a property manager that is authorized to address issues related to security, maintenance and code violations. Use additional sheets if needed for other parties. Reference ordinance for definition of “Owner” on vacant properties 

40. Owner Name
41. Owner Company Name
43. Owner address
44. Owner City, State & Zip
46. Day Phone
47. Email
48. Emergency Phone Number
50. Authorized Agent

    Please fill out Authorized Agent contact information if none then indicate N/A

52. Authorized Agent Name
53. Authorized Agent Company Name
55. Authorized Agent Address
56. Authorized Agent City, State & Zip
58. Authorized Agent Phone
59. Authorized Agent Email
60. Authorized Agent Emergency Phone Number
62. Other Contact Info

    Click if you have a Property Manager for property or Other Party if someone else has a legal interest in said property

    1. Property Manager
    2. Other Property with Legal Interest
64. Property Manager Name
65. Property Manager Company Name
67. Property Manager Address
68. Property Manager City, State, Zipcode
70. Property Manager Phone Number
71. Property Manager Email
72. Property Manager Emergency Phone Number
74. Other Party Name
75. Other Party Company Name
77. Other Party Name Address
78. Other Party City, State & Zipcode
80. Other Party Phone Number
81. Other Party Email
82. Other Party Emergency Phone Number
84. Utilities
86. Water

    1. On
    2. Off
87. Electricity

    1. On
    2. Off
88. Winterized

    1. On
    2. Off
90. Pending Litigation

    1. No
    2. Yes

    List all cases, including bankruptcy or foreclosure, or enter “None.” Attach additional sheets if needed. 

92. 1. Case Name/Type
93. 1. Case Number
95. 2. Case Name/Type
96. 2. Case Number
98. 3. Case Name/Type
99. 3. Case Number
101. If additional cases upload here
103. Signature:
104. Date:
Leave This Blank:


105. 1. Receive an email copy of this form.
106. Email address

     This field is not part of the form submission.

107. Submit

* indicates a required field