Rad Form 9 - Certificate Of Notice To Rad Of Adjustments In Rent Charged printable pdf download

RAD Date Stamp

District of Columbia Department of Housing and Community Development

Housing Regulation Administration – Rental Accommodations Division (RAD)

1800 Martin Luther King Jr. Avenue SE, 2

Floor

Washington, DC 20020

Internal Use Only

(202) 442-9505

C/O current:

□yes □no □n/a

CERTIFICATE OF NOTICE TO RAD

BBL current: □yes □no

OF ADJUSTMENTS IN RENT CHARGED

Reg. current: □yes □no

HOUSING PROVIDER(S) SHALL FILE THIS CERTIFICATE WITH THE RENTAL

ACCOMMODATIONS DIVISION. THIS FORM IS NOT SERVED ON TENANTS.

I, ________________________________________, declare, affirm and ratify as follows:

(Housing Provider’s Name)

1. I am the Housing Provider of the following Housing Accommodation or Rental Unit(s)

(address):_______________________________________________________________

Washington, D.C. ________________________________________________________

2. My business address is (No P.O. Box): __________________________________________

_______________________________________________________________________

3. My business telephone number and email address are:

_______________________________________________________________________

4. The Certificate of Occupancy number for the Housing Accommodation is _______________.

5. My Basic Business License number is _____________and expires on (date): _____________.

6. My RAD Registration Number for the Housing Accommodation is: ____________________

7. Attached hereto are the following documents related to the adjustment(s) in the rent charged for the

Housing Accommodation and the Rental Unit(s): (1) a sample “Housing Provider’s Notice to Tenants of

Adjustment in Rent Charged” (except for Vacancy Increases); and (2) a completed “Appendix of Notices

of Adjustments in Rent(s) Charged.”

8. The “Housing Provider’s Notice to Tenants of Adjustment in Rent Charged” was served on each of the

Tenant(s) listed in the “Appendix of Notices of Adjustments in Rent(s) Charged” prior to the filing of this

“Certificate of Notice to RAD of Adjustments in Rent Charged.”

9. The Rental Unit(s) and common elements of the Housing Accommodation are in substantial compliance

with the Housing Code as required by 14 DCMR § 4216.2 (2004), or any noncompliance is the result of

Tenant neglect or misconduct.

I declare, affirm and ratify under penalty of perjury that the foregoing information is complete and accurate

to the best of my knowledge. I fully understand and acknowledge that my signature below shall be deemed

as the taking of an oath or affirmation regarding all of the information provided herein, to which the

sanctions for perjury, false swearing or false statements under D.C. OFFICIAL CODE §§ 22-2402, 2404 &

2405 (Supp. 2008), respectively, shall apply.

_____________________________

__________________________

____________________

Housing Provider’s Printed Name

Housing Provider’s Signature

Date

Page 1 of 3

RAD Form 9 (rev 02/12)

Rad Form 9 - Certificate Of Notice To Rad Of Adjustments In Rent Charged

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