Form Ccs-Frm-274 - Multi-Tenant Registration Application And Renewal printable pdf download

______________

Account Number:

Multi-Tenant Registration Application

Renewal

New

IMPORTANT!!! - A CERTIFICATE OF REGISTRATION WILL NOT BE ISSUED UNTIL ALL CURRENT FEES AND FINES RESULTING FROM THE OPERATION

OF THE MULTI-TENANT PROPERTY (OR PROPERTIES) ARE PAID OR SETTLED. ALL OF THE INFORMATION REQUIRED IN THE APPLICATION MUST BE

PROVIDED IN ORDER TO PROCESS THE REGISTRATION.

(FOR OFFICE USE ONLY)

______________________________

_______/______/_______

ACCOUNT NUMBER:

DATE PAID:

$_________________

: ___________________________

LICENSE FEE PAID:

INSTRUMENT NUMBER

INSTRUMENT TYPE: [ ] CK [ ] MO [ ] CC [ ] CASH

_____________________________________________________________

PAYOR:

(If different than customer/applicant, capture address, C/S/Z, phone number)

___________________________________________________________

ADDRESS:

___________________________ STATE: _____ ZIP: __________-________

_______-__________

CITY:

PHONE: (______)

This application must be completed by the person who owns, operates, or controls the property, and returned with the applicable,

nonrefundable fee of $6.00 per unit, whether occupied or unoccupied. Please update any information that is incorrect on this application in

the spaces provided below.

Applicant’s Name:

Applicant’s Phone No:

Applicant’s Address / Zip Code:

Multi-Tenant Property or Properties owned by an: ___Individual ____Corporation ____Partnership ____ Other: _______________________

(Specify)

__________________________________________________________________________________________________

Property Owner(s) of Record:

Property Owner(s) Address:

___________________________________________________________________________________________________

Property Owner(s) Business Phone: _________________________ Fax: ___________________ Email: ____________________________________

If this property is owned by a corporation, provide the following information:

1. Name of Corporation’s Registered Agent: ___________________________________Phone: ____________________ Fax: ____________________

2. Registered Agent Address: __________________________________________________________________________________________________

3. Name of Corporation’s President: _________________________________________ Phone: ____________________ Fax: ____________________

4. Corporation’s President Business Address:____________________________________________________________________________________

If property owned by a partnership or other business association, provide name, address and telephone number of a high managerial agent. “High

Managerial Agent” means partner(s) in a partnership, officer(s) of a business association, director(s) of a business association, or any agent/employee

who has the duties of such responsibility that the agent’s/employee’s conduct represents the policy of the partnership or business association.

Name(s) of High Managerial Agent(s): ___________________________________________________________________________________________

Job Title of Managerial Agent(s): _______________________________________________________________________________________________

Business Address(s) of High Managerial Agent: __________________________________________________________________________________

________________________________________________________________________

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

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CCS-FRM-274

Effective Date 10/1/2015

Rev 7