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
Washington, DC 20020
Internal Use Only
□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)
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
Page 1 of 3
RAD Form 9 (rev 02/12)