Fillable RHIP Registration Form Revised 9-13 18 (City of Madera)

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RHIP Registration Form Revised 9-13 18 (City of Madera)

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The RHIP Registration Form Revised 9-13 18 (City of Madera) form is 1 page long and contains:

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  • 2 check-boxes
  • 40 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Madera

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State:
Contact Phone #: Emergency Phone #:
State:
State:
Office Phone #: Emergency Phone #:
Box 1
Box 2
Circle Answer Yes No
Yes No
Office Use Only: Date Rec'd _____/_____/_____
Rec'd by:_______________________________________________
Rev. 9/12/2018
STATEMENT OF DECLARATION
Occupied by Family Member:
Owner Signature:
Inspected by another government agency.
(Agency name):
Rent Charged:
Date of Birth (DOB):
Rental Business Name:
Owner Signature:
Under penalty of perjury, I declare that this unit does not qualify as a "rental housing" unit as defined in the City of Madera
Municipal code §4-16.03 for Rental Housing Inpections and therefore not subject to the routine inspections by the City as
required by section §4-16.06. Please check Box 1 or 2:
______________________________
PROPERTY MANAGER INFORMATION
OWNER(S) INFORMATION
RENTAL PROPERTY INFORMATION
Street Address: _________________________________________________________________ Zip Code: ______________
Additional Information:
Unit Information (# of each type of unit)
Studio: _____ One Bedroom: _____ Two Bedrooms: _____ Three Bedrooms: _____ Four Bedrooms: _____ Total Buildings:_____
APN: _________________________________ Single Family □ Multiple Units □ Total # of Units: __________
Property Owner(s) Name(s):
Email:
Additional Information:
RENTAL HOUSING REGISTRATION FORM
NEIGHBORHOOD REVITALIZATION DEPARTMENT
330 S C STREET, MADERA, CALIFORNIA 93638
(559) 661-5114
RENTAL BUSINESS LICENSE
Tenant confirmation
Tenant Signature:
Additional Information:
City:
Mailing Address:
Email:
Local Contact Representative Name:
Local Contact Representative Business Name:
City:
Mailing Address:
City:
Office Address:
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RHIP Registration Form Revised 9-13 18 (City of Madera)

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Completed 12 February 2021

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