Fillable RRIP ANNUAL EXEMPTION AFFIDAVIT %28002%29

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RRIP ANNUAL EXEMPTION AFFIDAVIT %28002%29

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U.S.A. forms for City of Hayward

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Code Enforcement Division - Rental Housing Inspection Program - 777 B Street, Hayward, CA 94541-5007 - (510) 583-4175
RRIP ANNUAL EXEMPTION AFFIDAVIT
Date:
PROPERTY ADDRESS:
1. Property Owner Information
Owner Name:
Owner Address:
Owner Phone #:
Owner Email:
2. Names of Adults Living on Premises
Name:
Relationship:
Name:
Relationship:
Name:
Relationship:
3. Declaration
I/We attest the above person(s) does/do not pay any rent of other form of compensation to
occupy these premises. I further declare that I do not claim any expenses related to this property
as a tax deduction on my person income taxes.
PROPERTY OWNER’S SIGNATURE:
Return completed form with a copy of a utility bill to:
City of Hayward – Code Enforcement Division
Rental Inspection Program
777 B Street
Hayward, CA 94541
NOTE TO OWNERS: Only single-family homes qualify for an exemption. A utility bill must be in
the name of the property owner to qualify for an exemption.
RRIP Annual Exemptions expire on Dec 31
st
of each calendar year. A new exemption request
must be submitted annually.
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RRIP ANNUAL EXEMPTION AFFIDAVIT %28002%29

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Completed 11 July 2020

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