Village Of Northbrook Vacant Building De-Registration
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1VILLAGE OF NORTHBROOK
Department of
Development & Planning Services
1225 Cedar Lane
Northbrook, Illinois 60062
847 664-4050
FAX: 847 272-5068
Vacant Building De-Registration
Complete this form for any changes in status of a previously registered vacant building, or for any change in ownership,
management, or mailing address for the property. This form must be completed and submitted within thirty (30) days of the
change in status of the property.
(*If the property you are now registering has never been registered, please use our vacant building registration form*)
Please print clearly in ink
A. PROPERTY INFORMATION
PROPERTY ADDRESS
If the name or address of the owner of a vacant building changes for any reason, a new registration will be required within 15 days of the change.
PREVIOUS OWNER NAME
PHONE (DAYTIME)
PREVIOUS OWNER MAILING ADDRESS (P.O. Box is not an acceptable address)
E-MAIL ADDRESS
Provide and attach a copy of the warranty deed or bill of sale
DATE OF SALE
IS PROPERTY OCCUPIED?
DATE OF OCCUPANCY
NEW OWNER NAME
PHONE
NEW OWNER ADDRESS (P.O. Box is not an acceptable address)
E-MAIL ADDRESS
Identify all persons other than the Owner who have a legal interest in the building or the premises. This can include but not be limited
to owners, attorney (if not in foreclosure) or Real Estate Agents: (use a separate sheet if necessary):
PHONE
EMAIL
NAME
ADDRESS
B. CONTACT INFORMATION
Provide the name, street address, email address & telephone number of the agent that is to be contacted regarding any identified concerns,
code violations, etc. with respect to the subject property:
PHONE
EMAIL
NAME
ADDRESS (P.O. Box is not an acceptable address)
Signature
Date
Phone
Email
Office Use Only: Village Approval Status
_____________
________________
Approved: by:
date:
_____________
________________
Not Approved:
by:
date:
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