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2. IMPORTANT MESSAGE

   Registration is required every year and within 30 days of any change in contact information.  

4. A complete registration form is required annually. It is unlawful for any person to engage in the business of rental housing unless this completed registration form is provided to the City of Citrus Heights, and the annual registration and Housing Stock Fees are paid. A new registration form must be submitted no later than 30 days after a change of owner, agent or rental status. One registration form is required per rental property.
6. Type of Registration*

   1. New Registration
   2. Annual or Renewal Registraton
   3. Update Contact Information
8. PROPERTY INFORMATION
10. Type of Dwelling

    1. Single-Family
    2. Duplex
    3. Triplex
    4. Fourplex
    5. Other Multi-Family
    6. Apartment Complex
11. Number of Rental Units
12. Complex Name
14. Citrus Heights Property Address*
15. City, ST

    Citrus Heights, CA

16. Zipcode*
    -- Select One --9561095621
18. Parcel Number *

    Need Help Finding Your Parcel Number?

20. Property Manager*

    1. I manage my own property

    1. I have a Property Manager
22. **Some rental units may be exempt from this program as determined by and to the satisfaction of the Director of Code Enforcement. If you believe your property or a portion of units whithin is exempt from this program, please complete the Application for Exemption.
    Exempt categories include properties newly constructed within the last five years; units inspected by other government agencies such as Sacramento Housing and Redevelopment Agency (SHRA) or similar; or if the unit(s) is not a "residential housing unit." Complete an Application for Exemption Form at www.citrusheights.net/RHIPExemptionForm if you believe your rental unit is exempt. Supporting documentation is required.
26. OWNER INFORMATION*

    Are you the Owner?

    1. I am the Property Manger Filing on behalf of the Property Owner
    2. I am the owner of the property identified by the previously listed address and APN
27. Management Agreement
    Attach a copy of the Management Agreement authorizing you to sign on behalf of the owner of the identified property.
29. Owner Name*
31. Owner Mailing Address
33. City, State
    Enter your mailing address City and State
34. Zip
36. Owner Daytime Phone #*

    Enter your 10-digit phone number with no special characters. Registration forms without an Owner phone number will not be accepted

37. Owner Cell #
38. Owner Email Address*
42. PROPERTY MANAGER INFORMATION
    A Property Manager must be authorized to accept service of all notices from the City of Citrus Heights RHIP and be able to be present for inspections
43. Property Manager/ Contact Name
45. Property Manager Mailing Address
47. City, State
48. Zip
50. Manager Daytime Phone #
51. Manager Alternate Phone #
52. Manager Email Address
56. Tenant Information
    The following information is OPTIONAL. Tenant information is used to contact tenants prior to scheduling an inspection.
58. Tenant Name
59. Tenant Address
61. Tenant Daytime Phone
62. Tenant Cell Phone
63. Tenant Email
65. Tenant Name
66. Tenant Address
68. Tenant Daytime Phone
69. Tenant Cell Phone
70. Tenant Email
72. Tenant Name
73. Tenant Address
75. Tenant Daytime Phone
76. Tenant Cell Phone
77. Tenant Email
79. Tenant Name
80. Tenant Address
82. Tenant Daytime Phone
83. Tenant Cell Phone
84. Tenant Email
88. ELECTRONIC SIGNATURE AGREEMENT*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree. Electronic Signature
90. It is unlawful for any person to knowingly make a false statement of fact or knowingly omit any information that is required to register a rental housing unit (CHMC 50-247)
92. Electronic Signature*
93. Date*
    Date
Leave This Blank:


94. 1. Receive an email copy of this form.
95. Email address

    This field is not part of the form submission.

96. Submit

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