Form Ccs-Frm-274 - Multi-Tenant Registration Application And Renewal (Page 2 of 2) in pdf

Account No.

Customer No.

Multi-Tenant Property Information Form

Attach to the Multi-Tenant Registration Application

Renewal

New

IMPORTANT!!! – A separate form must be completed for each Multi-Tenant Property being registered Use additional copies of this form to register more

than one Multi-Tenant Property. Attach form(s) to the Multi-Tenant Registration Application.

Name of Multi-Tenant Property:

Also known as (Aka):

Address of Multi-Tenant Property:

Property Phone No:

Property Fax No:

Property E-Mail:

No. of Buildings: _________ No. of Dwelling Units: ____________ No. of Pools: __________

No. of Spas: ______________

Total No. of Bedrooms: ______________ (A unit with no separate bedroom will be counted as one bedroom)

Current Occupancy Rate Expressed as a Percent: ________________% Certificate of Occupancy #_______________________________.

Is the owner an entity? [ ] Yes [ ] No

If yes, a copy of the documents establishing the business must be submitted with this application.

Type of Property:

[ ] Apartment [ ] Boarding Home [ ] Three-plex [ ] Four-plex [ ] Group Home [ ] Loft [ ] Town home

[ ] Condo – Individual Unit (Suite) Numbers of Rental Units must be noted here __________________________________________

Type of Boarding Home:

[ ] Handicapped Group Dwelling [ ] Lodging or Boarding House [ ] Residential Hotel [ ] Group Residential Facility

[ ] Extended Stay Hotel or Motel

Phone

Property Manager’s Name:

_______________________________________________

______________________

Property Manager’s Address:

Phone:

_______________________________________________

______________________

Do you currently offer recycling to your residents? [ ] Yes

[ ] No

The Multi-Tenant manager / person in charge must also provide the following information if applicable:

Name of Property Lien holder(s):

Address of Property Lien holder(s):

Phone #s’ of Property Lien Holders:

Name of Insurance Provider:

Phone

Address of Insurance Provider:

Name of Crime Watch Attendant Designee:

Phone

Address of Crime Watch Designee:

Alternate Contact Name/Address/Phone:

I am the person who owns, controls, or operates the Multi-Tenant property that is the subject of this application. I have read the completed application and know the same

is true and correct and hereby agree that, if a certificate of registration is issued, I will comply with all applicable provisions of Chapter 27 of the Dallas City Code, as

amended, and all applicable state laws. I accept responsibility for payment of all fees and fines that may result from the operation of the Multi-Tenant property.

Signature of Owner/Operator/Person in Control (Required)

Driver’s License or Identification Number – Issuing State (Required

)

Page 2 of 2

CCS-FRM-274

Effective Date 10/1/2015

Rev 7