On or before July first, nineteen hundred fifty-four, every owner of a multiple dwelling shall file with the department a statement, in duplicate, on a form to be prepared by the department substantially as follows: Owner of record: ………………………………………………. Street No. or other identifying description: ……………………… Type of construction: …………………………………………..

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(frame, brick, stucco, etc.) Height of building: …………….No. of stories: ……………….. Number of rooms or apartments for which designed: …………………. Number of persons in occupancy: ………………………………….