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Designated Agent Registration Form

  1. Please complete all fields of this form. Read all fields carefully.
  2. Will this person be the Primary Contact for the property/ies?*
  3. Please apply this designated information to:*
  4. Is this the first person/agency you are assigning to this property, or is this person/agency replacing an existing Designated Agent?*
  5. This Designated Agent information needs to be updated for the following Housing & community Development programs:
    Please select all that apply
  6. Note: Regardless of the designation of a primary agent, the City will still notify the property owner on record in cases of exterior nuisance violations as required by state law. All other license and inspection documentation will be mailed to the primary agent.
  7. This e-form serves as official notification that I, as the property owner of the above mentioned property(ies), do hereby designate the party listed below, as the "Designated Agent", empowered as the owners' representative in matters related to the City of Dubuque Property Maintenance Code and other requirements of Title 14, Chapter 1, Article J of the City of Dubuque Code of Ordinances and all other applicable codes.
  8. Designated Agent Information
  9. By submitting this form, I verify that all information is true and accurate.
    Please contact the Housing & Community Development Department at (563)589-4231 or with questions or for more information.
  10. Leave This Blank:

  11. This field is not part of the form submission.