"Registration of Delaware Owner/Lessor/Lessee" - Delaware

This Delaware-specific printable "Registration of Delaware Owner/Lessor/Lessee" is a part of the legal paperwork issued by the Delaware Department of Agriculture.

Download the up-to-date PDF by clicking the link below and mail it as per the guidelines provided by the department.

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Download "Registration of Delaware Owner/Lessor/Lessee" - Delaware

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DELAWARE HARNESS RACING COMMISSION
REGISTRATION OF DELAWARE OWNER/LESSOR/LESSEE
(1) NAME OF
OWNER/LESSOR/LESSEE_______________________________________________________________________
(2) HOME ADDRESS ______________________________________________________________________________
A. How long have you lived at this address? __________________________________ Own________ Rent______
B. How long have you lived in Delaware?___________________________________________________________
C. Is the HOME ADDRESS listed above used by you for the payment of taxes, including
federal, state and property taxes?
Yes_______
No ________
D.
Is the home address listed above the residence claimed by you on any loan application or
other similar document?
Yes_________
No _________
If the answer is “NO”, what addresses have you used for such purposes?
_________________________________________________________________________________________
E. List the utility providers to your Delaware residence:
_________________________________________________________________________________________
(3) In what state(s) are your personal automobiles registered and please give the registration numbers for each state:
_____________________________________________________________________________________________
(4) In what state do you hold a driver’s license? ________________________________________________________
Give driver’s license number_____________________ Date of issue ____________________________________
(5) In what state are you registered to vote?____________________________________________________________
(6) List properties you own in other states:____________________________________________________________
____________________________________________________________________________________________
(7) List any civic, community or other organization(s) in Delaware of which you are a member
____________________________________________________________________________________________
PLEASE PROVIDE DOCUMENTS TO PROVE YOU ARE A DELAWARE RESIDENT.
I HEREBY SWEAR OR AFFIRM THAT ALL OF THE FOREGOING INFORMATION IS TRUE AND I
UNDERSTAND THAT ANY INCORRECT, UNTRUTHFUL OR FRAUDULENT INFORMATION PROVIDED ON
THIS FORM MAY SUBJECT ME TO CRIMINAL AND ADMINISTRATIVE PENALTIES, INCLUDING, BUT NOT
LIMITED TO A MINIMUM FINE OF $5,000 AND A MANDATORY TWO-YEAR REVOCATION OF MY
HORSEMAN’S LICENSE.
_______________________________________
________________________________________________
Signature of Owner/Lessor/Lessee
Address
_______________________________________
________________________________________________
Print Name
DATE: ________________________________
Residential Phone Number __________________________
Cell Phone Number _______________________________
APPROVED BY:_____________________________
DHRC
DATE: __________________________________
Entered on Delaware Owned List on ___________________________(Date)
Print Form
DELAWARE HARNESS RACING COMMISSION
REGISTRATION OF DELAWARE OWNER/LESSOR/LESSEE
(1) NAME OF
OWNER/LESSOR/LESSEE_______________________________________________________________________
(2) HOME ADDRESS ______________________________________________________________________________
A. How long have you lived at this address? __________________________________ Own________ Rent______
B. How long have you lived in Delaware?___________________________________________________________
C. Is the HOME ADDRESS listed above used by you for the payment of taxes, including
federal, state and property taxes?
Yes_______
No ________
D.
Is the home address listed above the residence claimed by you on any loan application or
other similar document?
Yes_________
No _________
If the answer is “NO”, what addresses have you used for such purposes?
_________________________________________________________________________________________
E. List the utility providers to your Delaware residence:
_________________________________________________________________________________________
(3) In what state(s) are your personal automobiles registered and please give the registration numbers for each state:
_____________________________________________________________________________________________
(4) In what state do you hold a driver’s license? ________________________________________________________
Give driver’s license number_____________________ Date of issue ____________________________________
(5) In what state are you registered to vote?____________________________________________________________
(6) List properties you own in other states:____________________________________________________________
____________________________________________________________________________________________
(7) List any civic, community or other organization(s) in Delaware of which you are a member
____________________________________________________________________________________________
PLEASE PROVIDE DOCUMENTS TO PROVE YOU ARE A DELAWARE RESIDENT.
I HEREBY SWEAR OR AFFIRM THAT ALL OF THE FOREGOING INFORMATION IS TRUE AND I
UNDERSTAND THAT ANY INCORRECT, UNTRUTHFUL OR FRAUDULENT INFORMATION PROVIDED ON
THIS FORM MAY SUBJECT ME TO CRIMINAL AND ADMINISTRATIVE PENALTIES, INCLUDING, BUT NOT
LIMITED TO A MINIMUM FINE OF $5,000 AND A MANDATORY TWO-YEAR REVOCATION OF MY
HORSEMAN’S LICENSE.
_______________________________________
________________________________________________
Signature of Owner/Lessor/Lessee
Address
_______________________________________
________________________________________________
Print Name
DATE: ________________________________
Residential Phone Number __________________________
Cell Phone Number _______________________________
APPROVED BY:_____________________________
DHRC
DATE: __________________________________
Entered on Delaware Owned List on ___________________________(Date)
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