Resident Registration

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City of Reading

Citizens Service Center

815 Washington Street

Reading PA 19601-3690

Phone: 1-877-727-3234

csc@readingpa.gov

 

Individual Registration

 

The following information is necessary for our records and will be held in strict confidence. All applicable sections must be completed. Every individual in the household, age 18 or older, must complete a registration questionnaire if they are not already on file with the City of Reading for Per Capita Tax purposes.

 

Name:  _________________________   _______________   ____________________________   ____________________________

             First                                               Middle                        Last                                                  (Maiden)

 

Social Security Number:  _______________________________          Birthdate:  _____ /_______ /_________

                                                                                                                                                           Month          Day            Year

 

Current Addess:_____________________________________________________________________________

 

Phone Number: _____________________________________________________________________________

 

Date you became a resident of the above listed address:                       ________/________ /__________

                                                                                                                                      Month            Day                 Year

 

Previous address(s) and the date(s) of residency therein (use back of form for additional address if needed):

 

              _____________________________________________________________________________

 

              _____________________________________________________________________________

 

If employed or self-employed list employer’s name and business address:

 

               ____________________________________________________________________________

 

               ____________________________________________________________________________

 

If no employer information was provided above, please check reason:

 

Housewife ( )   Retired ( )   S.S.I. ( )   Disability ( )   Public Assistance ( )   Student ( )  

 

Active Military ( )   Other ( )_______________

Provide documentation

Please list below and on the back of this form if needed, the name, birthdate and social security number of any individuals 18 years or older, in addition to yourself, that reside in your household.

 

____________________________________________________________________________________

 

____________________________________________________________________________________

 

 

Signature: ___________________________________ Date:___________________________________

 

 

The facts set forth herein are made subject to the penalties of 18 PA C.S. Sec. 4904 relative to unsworn falsifications to authorities.

 

All individuals should notify the Citizens Service Center within 30 days of any change of address so that our records may be updated.

 

Please forward this form to the address listed, at the top of the form, by mail, by email, or in person.

For CSC office use only:                Applicant/contact #___________________________________________

                                                        Per Capita              ___________________________________________