Ithaca, NY · Tompkins County
Owner Occupancy Statement
Property owners use this statement to report the occupancy and rental status of a property in Ithaca and provide their contact information.
What this form is
The statement records whether a property has been rented, is used as a primary residence, or will no longer be rented. Owners provide the property address, contact details, rental dates or other information, and a signature and date. By signing, the owner acknowledges the inspection requirement before renting and the need for a valid Certificate of Compliance.
Who needs it
An owner of an Ithaca property who is reporting its occupancy or rental status should complete and submit this statement.
How to submit it
Remit the completed statement to the City of Ithaca Building Division, 108 East Green Street, 4th Floor, Ithaca, New York 14850.
About notarization
This document is signed without a notary; the owner swears the information is true and accurate, then signs and dates the statement.
How to submit this form
- 1
Download The Statement
Download the Owner Occupancy Statement PDF.
- 2
Complete The Form
Print your responses, provide the property and contact information, check the applicable statements, and sign and date the form.
- 3
Review The Statement
Check that your occupancy and rental information is complete and accurate.
- 4
Submit To The Building Division
Remit the completed statement to the City of Ithaca Building Division at the address listed on the form.
Frequently asked questions
- What does the Owner Occupancy Statement report?
- It records whether a property has been rented, is used exclusively as a primary residence, or will no longer be rented, along with relevant dates and owner contact information.
- Who completes the Owner Occupancy Statement?
- An owner of the property identified on the form completes the statement, checks the applicable occupancy or rental information, and provides a signature and date.
- Do I need a notary for the Owner Occupancy Statement?
- No. The document has no notary block; the owner swears the information is true and accurate and signs and dates the statement.
- How do I submit the Owner Occupancy Statement?
- Remit the completed statement to the City of Ithaca Building Division at 108 East Green Street, 4th Floor, Ithaca, New York 14850.
Need something notarized?
This Owner Occupancy Statement doesn’t need a notary — but if you have another Ithaca form that does, a commissioned online notary can help.