REGISTRATION APPLICATION FOR RESIDENTIAL RENTAL UNIT

$5.00 PER BUILDING/FIVE YEAR PERIOD

1. NAME, ADDRESS AND TELEPHONE NUMBER OF OWNER:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

2.             PLEASE PROVIDE THE NAME, ADDRESS AND TELEPHONE NUMBER OF ANY AGENT OR REPRESENTATIVE IN CHARGE OF THE REGISTERED PROPERTY:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

3.             STREET ADDRESS OF STRUCTURE BEING REGISTERED:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

4.             TYPE OF STRUCTURE/CHECK ONE:             (SEE DEFINITIONS ON REVERSE SIDE)

                A._____NO LONGER A RENTAL UNIT

                B._____SINGLE RENTAL UNIT IN AN OWNER-OCCUPIED STRUCTURE

                C._____SINGLE FAMILY UNIT

                D._____TWO FAMILY UNIT

                E._____MULTI-FAMILY STRUCTURE (3 OR MORE UNITS)

                                (INDICATE NUMBER OF UNITS:_____)

                F._____ROOMING/BOARDING HOUSE

5.             BASED ON THE TYPE OF STRUCTURE IDENTIFIED IN QUESTION NO. 4, INDICATE THE NUMBER OF OCCUPANTS PER DWELLING UNIT AND WHETHER THEY ARE RELATED OR UNRELATED (TO EACH OTHER):  (SEE DEFINITIONS ON REVERSE SIDE)

A. SINGLE FAMILY UNIT IN AN OWNER-OCCUPIED STRUCTURE:

_____(RELATED)                                                               _____(UNRELATED)

B. SINGLE FAMILY UNIT:

_____(RELATED)                                                               _____(UNRELATED)

C. TWO FAMILY UNIT:

UNIT #1_____(RELATED)                                                _____(UNRELATED)

UNIT #2_____(RELATED)                                                _____(UNRELATED)

D. MULTI-FAMILY STRUCTURE:

UNIT #1_____(RELATED)                                                _____(UNRELATED)

UNIT #2_____(RELATED)                                                _____(UNRELATED)

UNIT #3_____(RELATED)                                                _____(UNRELATED)

UNIT #4_____(RELATED)                                                _____(UNRELATED)

UNIT #5_____(RELATED)                                                _____(UNRELATED)

UNIT #6_____(RELATED)                                                _____(UNRELATED)

E. ROOMING/BOARDING HOUSE:

_____(RELATED)                                                               _____(UNRELATED)

THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

__________________________________________                              ___________________________________________

                DATE SIGNED                                                                                     SIGNATURE OF APPLICANT

DEFINITIONS

IF YOU NO LONGER RENT THIS UNIT PLEASE CHECK THE APPROPRIATE BOX IN SECTION #4 ON SIDE #1 OF THIS FORM THEN SIGN, DATE, AND RETURN IT.

TWO FAMILY UNIT:  A BUILDING HAVING TWO (2) DWELLING UNITS AND CONTAINING BUT TWO (2) FAMILIES AND MAY BE EITHER WITH ONE (1) FAMILY LIVING ON EITHER SIDE OF A COMMON WALL, OR WITH ONE (1) FAMILY LIVING OVER THE OTHER.

MULTI-FAMILY UNIT:  A BUILDING HAVING THREE (3) OR MORE DWELLING UNITS AND DESIGNED TO BE USED OR OCCUPIED AS A RESIDENCE BY THREE (3) OR MORE FAMILIES LIVING INDEPENDENTLY OF EACH OTHER.

ROOMING/BOARDING HOUSE:  ANY STRUCTURE IN WHICH MORE THAN FOUR (4) PERSONS EITHER INDIVIDUALLY OR AS FAMILIES ARE HOUSED OR LODGED FOR HIRE WITH OR WITHOUT MEALS BUT WITHOUT SEPARATE COOKING OR SANITARY FACILITES.  A ROOMING HOUSE, FURNISHED ROOM HOUSE, OR TOURIST HOME SHALL BE DEEMED A BOARDING HOUSE.  ANY DWELLING CONTAINING ONE OR MORE UNITS WITH AN OCCUPANCY OF MORE THAN FOUR (4) UNRELATED PEOPLE IN SUCH UNIT SHALL ALSO BE DEEMED A BOARDING HOUSE.

RELATED:  AN INDIVIDUAL, OR TWO OR MORE PERSONS, RELATED BY BLOOD OR MARRIAGE.

UNRELATED:  INDIVIDUALS, NOT RELATED BY BLOOD OR MARRIAGE, LIVING TOGETHER AS A SINGLE HOUSEKEEPING UNIT.