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2. Property Owner*
3. Property Address*

5. I, (Property Owner), as owner of the property located (Property Address) at Hanover Park, Illinois acknowledge the following:

   1. I am the owner/landlord or managing agent and I am registered as required by the Village of Hanover Park Code Sec. 82-6 and I am current and in good standing with all my obligations to the Village of Hanover Park.

7. Personal or Business*

   1. Personal

   1. Business
9. Rental/Bus. Lic, Num.*
10. Exp. Date*
    Exp. Date
12. Rental/Business Number*
14. 2. That this property is a: *
    -- Select One --Single Family DwellingMulti-Unit DwellingCommercial w/Residential Dwelling

    Property Type

16. 3. That the above identified dwelling is serviced by its own individual meter located in the dwelling*

    1. Yes

    1. No
18. If answered No, where is the Meter located

20. 4. That the following Tenant has been authorized to set up a water/sewer bill in their own name and accepts responsibility for payment of the same, and that Tenants information as provided below is true and correct to the best of my knowledge:

22. Tenant(s) Name(s)*
23. Move in date*
    Move in date

25. 5. The rental agreement/lease for the above identified dwelling unit specifically requires that the Tenant be responsible for all water and sewer bills, and that the water and sewer service is not included in the rent. I understand that I will not be receiving a billing statement or late notices for the dwelling, unless specifically requested. I further agree that I assume full responsibility for monitoring the payment of the bill by the tenant.

    
    

    6. I authorize the Village of Hanover Park to accept partial payments from tenants on the water/sewer bills for my property.

    7. I have read and understand the Village of Hanover Park water policy as enumerated in Hanover Park, IL Code Chapter 106 and that I understand "the services of the combined waterworks and sewerage system shall be deemed to be furnished to the owner of the premises and to the occupant thereof and to the user of the services, and the owner and the occupant and the user shall be jointly and severally liable for the payment of all charges for such services; and such services are furnished to the premises by the village only upon the condition that the owner of the premises and the occupant thereof and the user of the services are jointly and severally liable therefor to the village."

    8. I understand that any unpaid water and sewer charges for service delivered to the premises will become a lien on the property unless they are paid in full according to the terms of the water and sewer policy.

    9. I authorize the Village of Hanover Park to maintain the water and sewer bills in the above tenant`s name as an "Associated Customer" and I agree, defend, indemnify and hold the Village, its officers, officials, and employees harmless from any and all claims, injuries, damages, losses or suits including attorney fees, arising out of or in connection with the administration of the Landlord and Tenant Agreement of Tenant Responsibility and the Village of Hanover Park Water Policy.

27. Owner/Landlord or Managing Agent*
28. Owner/Landlord Phone Number*
30. Owner/Landlord Address*
32. City*
33. State*
34. Zip Code*
36. Fax Number
37. Email Address*
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

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