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,1CATION FOR RENTAL REGISTRATION CERTIFICATE City of Centerville, Minnesota 2. 3. ,dons: Type or print in ink. Indicate if you are an owner, partner, association officer or agent/manager in charge of Allses. YOU MUST PROVIDE THE FULL NAME, INCLUDING FULL MIDDLE NAME, (no initials) AND DATE JF BIRTH FOR EVERY PERSON LISTED. 1. BusinessTYPe~"" Association Officer Rental Property Address: \ ~ \ t..\ Applicant Name: ~() 1:>\2..t0 (First) Partnership Agent/Manager \\" v,\....t:, LA \t..C U:: ~ 61 cf- (Middle) Corporation 4. Residence Address: 2 b' W~ '\1-1)\)\210 '{kvt:. YY\ \ p}..>~Y-Q U)) YV\. 0 No. of Units: I W\\z'/::,'oP L-l- b . 1- ) (Last) (Date of Birth) Phone: t-b~ . l-15~ - L 2 S 1- 'i'J. S~~b":>-Yf S'"L Position: 5. Ifpartnership, LLC, or Corporation, complete the following: Business Name: Business Address: How long have you been in business at this a~dress? Home office address: State of Incorporation Phone: Phone: Date of Incorporation List the full name, date of birth, residence address, and phone number for Chief Operating Officer of the partnership or LLC, or corporation. Full Name: (first) Residence Address: (middle) (last) (date of birth) Phone: 6. Fill out the information if dwelling is being sold on a Contract for Deed. Full Name: (middle) (last) (date of birth) Phone: ( first) Residence Address: Full Name: (middle) (last) (date of birth) Phone: ( first) Residence Address: i \ age lof2 Rental Certificate Application Rev. 12/99