Address
City
State
Zip
What type of building is it?	Single Family Residence Duplex Triplex Four-Plex Multifamily Dwelling
How long has the property been vacant?
Approximate Month Property First Vacant	Please Select January February March April May June July August September October November December
Approximate Year Property First Vacant (YYYY)	*Please enter Year e.g. 1996
Condition of Property?	Good Fair Poor Blighted
Do you have any contact information regarding the owner?	Yes No
If yes, please provide