New Rent Program Service Fee Application - City Of Oakland
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1
2For Office Use Only
ACCOUNT #:________________
CITY OF OAKLAND - FMA, Revenue-Business Tax
APN #:
_
250 Frank H. Ogawa Plaza, Suite 1320, Oakland, CA 94612
Phone: 510-238-3704
Fax: 510-238-7128
Website:
CITY OF OAKLAND
NEW RENT PROGRAM SERVICE FEE APPLICATION
20___
All residential rental properties are subject to pay Business Tax in the City of Oakland. To obtain a NEW RENTAL
APPLICATION, please visit their website at:
Note:
Please read all instructions on the other side before completing this application.
1.
PROPERTY OWNERSHIP REQUIRED
(Must match information on County Records)
LAST NAME
FIRST NAME
M.I.
A. __________________________________________________
______________________________________
B. __________________________________________________
______________________________________
C. __________________________________________________
______________________________________
2. RENTAL ADDRESS:
_______________________________________________________________
Number
Street
Suite
3. CITY: OAKLAND
STATE: CA
ZIP +4:_____________
4. RENTAL START DATE:________________
5. BUSINESS PHONE: _________________
_
EXT. ___
CONTACT PHONE:
EXT._______
6. MAILING NAME: ____________________________________________ ATTENTION:
___________________________
7. MAILING ADDRESS:
________ ________________
Number
Street
Suite
CITY:
STATE: ________ ____ ZIP +4: __________________________
8. DWELLING TYPE:_______ SFR = Single Family Residence, DUP = Duplex,
TRI = Triplex,
MUB = Multi-Unit Building (4 or More Units)
9. TOTAL # OF UNITS: __________
For Office Use Only
10. RENT ADJUSTMENT FEE: $30.00 X NUMBER OF UNITS CLAIMED ON LINE #9 =
$______________
Payment Type:
11. INDICATE # OF EXEMPT UNITS NEXT TO THE APPROPRIATE EXEMPTION.
(**See Reverse side for Exemptions**)
a.___ b.___ c.___
d.___ e.___ f.___
Date:
12. MULTIPLY THE NUMBER OF EXEMPT UNITS BY $30.00
=
$______________
Initials:
13. ENTER TOTAL AMOUNT DUE
=
$______________
(Subtract Total on Line #12 from Total on Line #10)
14. PAYMENT TYPE:
CREDIT/ DEBIT CARD
CHECK
MONEY ORDER
(DO NOT MAIL CASH)
CREDIT CARD NUMBER:_____________________________________
EXPIRATION DATE:
MO
YR
VISA
MASTERCARD
DISCOVER
AUTHORIZED SIGNATURE:__________________________________
I declare under penalty of perjury that to the best of my knowledge, all information contained on this application is true and complete:
SIGNED:
DATE:
_______
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