Need help in Filling out a Form For Assuming POS

[Mark Spritz]

I am buying a property in Cleveland Heights and assuming the POS. But it requires me to fill out the Registration of Dwelling Structure By Out-of-County Owners Form. In the form it has section II for Cuyahoga County Agent Information.

I do not understand what they are looking for. Does anyone know what is supposed to go in this section of the form?

Thanks

Mark