DELAWARE COUNTY, PENNSYLVANIA

DELAWARE COUNTY, PENNSYLVANIA
ASSESSMENT OFFICE ACT 29 — PROPERTY CONTACT INFORMATION FORM

County Property Contact Information List 68 Pa.C.S. Chapter 25

Effective Date: September 18, 2026

Use this form for real property that is not owner-occupied as the owner's principal residence.

Under 68 Pa.C.S. § 2504, owner-occupant real property is exempt from Chapter 25.

Submit completed form to the address below or online

Delaware County Assessment Office
Government Center — Ground Floor
201 West Front Street
Media, PA 19063
Phone: 610-891-4891
Property Assessment: 610-891-4887
PART 1 — PROPERTY INFORMATION
Delaware County Property/Parcel ID Number:
Enter 11 digits, no spaces
Property Address:

Street Address

City/Borough/Township

StatePostal / Zip Code

Municipality
Date Property was Purchased / Acquired:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Property Occupancy - Is this property owned by an individual as that individual's principal residence and domicile?

PART 2 — ADDRESS CONFIDENTIALITY PROGRAM
Are you a participant in Pennsylvania's Address Confidentiality Program under 23 Pa.C.S. § 6703? IF YES: You may not be required to provide your actual address or have your actual address disclosed under 68 Pa.C.S. Chapter 25. Contact the Delaware County Board of Assessments for instructions regarding an alternative address/contact procedure.
Note: The statutory definitions of "business," "limited liability company," and "real property owner" are found in 68 Pa.C.S. § 2501.

PART 3A — INDIVIDUAL OWNER

Complete this section if the property owner is an individual, then go to Part 4.
Full Legal Name:

First NameLast Name
Residential Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
Email:
example@example.com
Property Manintenance / Code Contact

If different from the owner listed, the individual below must have the authority and ability to repair, maintain, or otherwise remedy a problem or municipal code violation concerning the property.
Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
Email:
example@example.com

PART 3B — BUSINESS / ASSOCIATION OWNER

Complete this section if the property owner is a business or association other than an LLC, then go to Part 4.

Business Information
Legal Business Name:
Legal Business Name
Business Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number:

Area CodePhone Number
Owner / Employee Contact
Name of Owner or Employee:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
Email:
example@example.com
Property Maintenance / Code Contact

The individual listed below must have the authority and ability to repair, maintain, or otherwise remedy a problem or municipal code violation concerning the property.
Name of Individual / Representative / Employee:

First NameLast Name
Title / Position:
Title / Position
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
Email:
example@example.com

PART 3C — LIMITED LIABILITY COMPANY (LLC)

Complete this section if the property owner is an LLC, then go to Part 4.

LLC Information
Legal LLC Name:
Legal LLC Name
Company Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Phone Number:

Area CodePhone Number
Member / Manager
Name of Member or Manager:

First NameLast Name
Member or Manager Phone Number:

Area CodePhone Number
Email
example@example.com
Does the above individual have an ownership interest or right in the LLC?
Property Maintenance / Code Contact

The individual listed below must have the authority and ability to repair, maintain, or otherwise remedy a problem or municipal code violation concerning the property.
Name of Individual / Representative / Employee:

First NameLast Name
Title / Position:
Title / Position
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
Email:
example@example.com

You answered YES to a question in either Part 1 or 2, no need to complete this form.

If you made a mistake, please start over
Should be Empty: