OWNER INFORMATION FORM

 

As required by Chapter 51:10A please fill out this form and return it to:

Modica Associates Property Management

131 Park Drive        Boston, MA  02215

(fax) 617-236-7655

 

UNIT OWNER INFORMATION

 

Unit Owner Name:__________________________________________

 

Building:_________________________________ Unit:   __________________________

 

Vehicle Make:____________________    Model:__________Plate#:_________  Space # _______

 

 

If the address on the envelope in which you received this information is not entirely correct or if you would prefer we use a different address, please indicate the address below.

 

Mailing Address:________________________________________________________________

 

_____________________________________________________________________________

 

 

Home Telephone: ________________________________ Cell:______________________

 

Work Telephone:_________________________________ Pets:_______________

 

E-Mail Address:__________________________________

                                                                                                                       

Alternate contact person in case of an emergency in the unit:

 

Name:__________________________________________

 

Home Telephone: ________________________________

 

Work Telephone:_________________________________

 

TENANT INFORMATION (if applicable)

 

Tenant Names:  ________________________________________________________________

 

                        ________________________________________________________________

 

Home Telephone: ___________________________          Cell:____________________________

 

Work Telephone:____________________________          E-Mail Address:___________________

 

Emergency Contact: _________________________     Emergency Phone: _________________

 

 

The building’s insurance is designed to cover common area property only. A HO6 policy should be purchased by owners and tenants alike to cover their personal property, building deductibles, and any relocation and loss of use necessary to sustain them through a disaster. I.E. Flood or fire”

 

PLEASE VERIFY WITH THE MANAGEMENT COMPANY THAT WE HAVE A WORKING SET OF KEYS TO YOUR UNIT AND ALARM CODE IF APPLICABLE IN THE EVENT OF A LOCKOUT OR BUILDING EMERGENCY.

 

 

IMPORTANT INFORMATION:

Please circle correct information

What type of stove is in Unit:   Electric/Gas  If Gas, Electric Igniter or Need to manually relight pilot with match?

Please circle correct information

Circuit Breaker in Unit/Fuse Box in, please write-in location_____________________________________.