TOWN OF WYOMING

LANDLORD LICENSE APPLICATION

The undersigned applicant, as the authorized owner and or agent, hereby makes an application in accordance with Ordinance #33 of the Town of Wyoming

for a landlord license for a period to expire onSeptember 30, 20___ and submits the following information:

Applicant Name:______________________________________________________

Applicant’s Address:___________________________________________________

Telephone Number(s):_______________________    _________________________

Location of rental properties in Wyoming (please list all)

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

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Applicant’s Signature:__________________________________Date:_______________

For Office Use Only:

Town Clerk/Notary Signature:____________________________Date:_______________

Date Paid:__________Payment Method & #:_____________

Amount:__________License#: LL__________