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2. Property Address*
4. Property Owner*
6. Property is not a rental

   1. The property contains no dwelling unit, to be used for residential purposes, that is rented or available for rent.
8. Property is a rental but is exempt from the Rental Housing Inspections Program for the following reasons

   1. Property contains only one (1) dwelling unit.
   2. Property contains two (2) dwelling units, one (1) of which is occupied by the owner of the property.
   3. Property is owned and managed by the Moline Housing Authority, a municipal corporation.
   4. Property declared as condominium property under the Illinois Condominium Property Act, 765 ILCS 605/4 et seq., and amendments therto.
   5. Property containing facilities licensed under state or local law for operation as an assisted or shared living, nursing home or long-term care facility, a convalescent, or any other facility providing
   6. Hotels and motels, bed and breakfast establishments, or community reception establishments.
10. Comments
12. NOTE: If the power is off for more than six (6) months, it is required that plumbing and electrical fixtures be inspected before the gas and electricity are turned back on.
16. I certify and declare the information I have furnished on this form is true and complete to the best of my knowledge. I understand that if the status of my property changes from the above, I must contact the City of Moline Rental Housing Inspections office within fifteen (15) days of the change.
18. Signature Approval*

    1. I agree
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20. 1. Receive an email copy of this form.
21. Email address

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22. Submit

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