HomeMy WebLinkAboutRental Registration Certificate ApplicationAPPLICATION 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.
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2
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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
9. The tenant has a right to contact the City of Centerville's Building Inspection Department to request an inspection for
a $25.00 fee. If a violation is found, the tenant will receive a refund; if no violation is found the $25.00 fee will
become non-refundable.
APPLICANTS SIGNATURE MUST BE NOTARIZED
Signature of Owner/Applicant
Print Name
Date
(first) (middle) (last)
Subscribed and sworn before me a Notary Public
on this: day of
Notary Signature:
My Commission Expires on:
If you are not sure that your unit(s) meet the requirements of the 1997 Uniform Housing Code,
contact the Centerville Building Official to schedule an inspection at 651-429-4750.
The City of Centerville reserves the right to request additional information to assist in the evaluation of this application.
$110.00 for 1St unit/$25.00 per unit thereafter within the same structure.
Page 2 of 2 Rental Certificate Application Rev. 11-07