<p> City of Hazel Park 111 E. Nine Mile Hazel Park, MI 48030 </p><p>Abandoned Structure Registration Form</p><p>OWNER INFORMATION</p><p>Abandoned Structure Address: ______</p><p>Owner: ______</p><p>______</p><p>______</p><p>Date of Birth:______</p><p>Telephone: ______[of each owner]</p><p>______</p><p>*** Please attach proof of identification of each owner ***</p><p>AGENT/REPRESENTATIVE INFORMATION Individuals authorized by the Owner to handle the affairs of the property, including, but not limited to real estate agents, rental managers, property maintenance personnel</p><p>Name: ______</p><p>Address: ______</p><p>______</p><p>Telephone: ______</p><p>Reason for Vacancy:______</p><p>Name/Contact Information for the Mortgage Company: [If under foreclosure or deed in lieu of foreclosure has been provided] ______</p><p>Estimated time of vacancy: ______</p><p>Restoration/Timeline Schedule: ______</p><p>Fee: ______Receipt #: ______Date: ______MONTHLY ADMINISTRATION FEE</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p>