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2. Street Address*
4. Building Number(s)
5. Unit Number(s)
7. Total Number of Units*
8. Zip Code*

10. All residential rental properties are required to be registered and updated annually and upon a change of ownership or contact information. Online registration is encouraged by completing the Registration Form and submitting via email to npu@modestogov.com. All residential rental properties shall be registered, including those that may be considered exempt from inspections. This Registration Form may also be returned by mail to the address shown above. Registration is due no later than 30 days from receipt of initial notice. Failure to register a property may result in administrative remedies.

12. Property Owner Information

    To the extent legally permissible, the contact information shall remain confidential and for internal City of Modesto use only. 

14. First Name*
15. Last Name*
16. Email Address*
18. Primary Phone
19. Cell Phone*
21. Mailing Address*
23. City*
24. State*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
25. Zip Code*
27. Local Contact or Property Manager

    If different from the Owner, please list the contact information for a local representative with full authority to act on behalf of the Owner for all purposes under the Rental Housing Safety Program. 

29. Local Representative Same as Property Owner*
    -- Select One --YesNo
30. Company Name
32. First Name
33. Last Name
34. Email Address
36. Mailing Address
38. City
39. State
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
40. Zip Code
42. Primary Phone
43. Cell Phone
45. Declaration*

    1. I Agree

    I declare that I am the owner or local representative with full authority to act on behalf of the owner for the referenced property. I understand that it is unlawful for any person to knowingly make a false statement of fact or knowingly omit any information that is required to register a rental housing unit.

    I understand and acknowledge that all non-exempt rental housing properties and rental housing units are subject to routine periodic inspections by the City of Modesto. By signing below, I certify that I have read and understand the information contained on the within registration form. 

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47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

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