Residential Vacancy Declaration

Full Name of Property Owner or Authorized Agent

First NameLast Name

Contact Email Address

example@example.com

Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Property Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Type of Property

Date Vacancy Began

Date

Expected Duration of Vacancy

Reason for Vacancy

Is the property furnished?

Is anyone visiting or inspecting the property during the vacancy?

Additional Comments or Special Notes

Signature