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1. Roseville & Rocklin Residents

* 1. Residence Address:

* 2. Unit Type

* 3. Current Rent Amount:

* 4. Todays Date:

* 5. Number of Bedrooms & Bathrooms

* 6. Quality of Unit

7. The Unit is heated with:

8. The Stove uses:

9. Water Heating:

* 10. Owner Paid Utilities

11. Accessibility:

12. Amenities

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