Rental Registration Certificate Application

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APPLICATION FOR RENTAL REGISTRATION CERTIFICATE City of Centerville, Minnesota Directions: Type or print in ink. Indicate if you are an owner, partner, association officer or agent/manager in charge of premises. YOU MUST PROVIDE THE FULL NAME, INCLUDING FULL MIDDLE NAME, (no initials) AND DATE OF BIRTH FOR EVERY PERSON LISTED. 1 2 3 Business Type: Owner Rental Property Address: Applicant Name: Association Officer (First) (Middle) (Last) (Date of Birth) Position: Phone: 4. Residence Address: 5. If partnership, LLC, or Corporation, complete the following: Business Name: Business Address: Phone: How long have you been in business at this address? Home office address: Phone: State of Incorporation Date of Incorporation 6. Fill out the information for agent appointed by the owner to accept service of process or give receipt for notices. Full Name: (first) (middle) (last) (date of birth) Residence Address: Phone: 7. As the owner of the property, you are responsible for any utility charges (sewer, water and garbage). If you desire we will bill your tenant(s) (individually metered units only) and issue you a duplicate copy of the sewer and water bills for a fee of $10 per year. You will need to contact Waste Management at (952) 890-1100 if you desire a duplicate of the garbage bill. It is your responsibility to ensure that these utilities are paid as they will become a lien on the property and can be collected with property taxes pursuant to Minnesota State Statute 429.101 Subd. 1, (10). It is not the City's responsibility to collect these fees from your tenant(s). Do you want us to bill your tenant and issue you a duplicate of the sewer & water bill? 8. It is the landlord's/owner's responsibility to notify the tenant of all inspections prior to the arranged inspection. It is not the City's responsibility to notify your tenant. Corporation No. of Units: Partnership Agent/Manager Page 1 of 2 Rental Certificate Application Rev. 11-07