RESIDENTIAL RENTAL REGISTRATION APPLICATION
Building Department
Applicant Information
Name: _________________________________________________________________________________________
Company Name (if applicable): __________________________________________________________________
___
Address: _________________________________________ City: ________________________ State: ___________
Phone Number: __________________________ E-mail Address: _________________________________________
For the following properties, I am the:
Property Owner
: A person, corporation, or limited liability company claiming, or in whom is invested, the
ownership, dominion, or title of real property including but not limited to: holder of fee-simple title, holder of life-
estate, holder of leasehold estate for an interim term of five years or more; a buyer under contract for deed; a
mortgagee, receiver, executor or trustee in control of real property; but not including the holder of leasehold estate
or a tenancy for initial term of less than five years. (MH Cod. Ord. 1486.01(f))
Agent in Charge
: A resident of Cuyahoga County, Ohio, who has been designated by the owner of a rental property
located in the City of Maple Heights, to be the local agent-in-charge (AIC), to oversee the maintenance and financial
obligations of the property, when the owner of the property does not reside in Cuyahoga County, Ohio. The agent in
charge must be a resident of Cuyahoga County and register with the City for the property. (MH Cod. Ord. 1486.01(f))
Property Information
Address Property Owner & Phone Number
(if different from above)
1. ___________________________________________ _____________________________________________
2. ________________________________________
___
_____________________________________________
3. ________________________________________
___
_____________________________________________
4. ________________________________________
___
_____________________________________________
5. ________________________________________
___
_____________________________________________
6. ________________________________________
___
_____________________________________________
7. ___________________________________________ _____________________________________________
8. ________________________________________
___
_____________________________________________
9. ________________________________________
___
_____________________________________________
10. ________________________________________
___
_____________________________________________
Additional Required Information
The following documentation is required in order for this Rental Registration Application to be processed:
1. Proof of full payment of property taxes or documentation of being on a County payment plan in goo
d
s
tanding for each of the properties listed above.
2. A Tenant Information Form for each of the properties listed above.
3. A completed Regional Income Tax Agency (RITA) Form for both the property owner and each of the tenants.
RESIDENTIAL RENTAL REGISTRATION APPLICATION
Building Department
Statement and Signature Information
To the best of my knowledge, the foregoing statements are true and correct. I understand the Building Commissioner
reserves the right to refuse this application if found to be incomplete or improperly submitted. I understand that, if I
transfer ownership of one of the property(ies) above or acquire additional property, I must update this Rental
Registration within 30 days of transfer and pay a non-refundable $35 fee. Additionally, I understand that Rental
Registrations are not assignable or transferrable. Anyone falsifying information on this permit application is guilty of
falsification per Cod. Ord. Sec. 606.10(a)(5), a first degree misdemeanor, punishable by a fine up to $1,000 and a jail
term up to 180 days.
__________________________________ ______________________________________ ___________________
Applicant’s Printed Name Applicant’s Signature Date
Fee Information
All Rental Registration Applications shall be filed in a timely manner and submitted with the appropriate fee as
detailed below. Failure to file the Rental Registration Application, provide the Additional Required Information, or pay
the filing fee in a timely manner shall result in penalties prescribed in MH Cod. Ord. 1486.99, including but not limited
to being charged with a fourth degree misdemeanor for a first offense, a third degree misdemeanor for a second
offense, and a second degree misdemeanor for each and every subsequent offense. A separate violation shall be
committed for each day and each rental unit that is not properly registered. Knowingly submitting a false statement
as part of the application or inspection process for rental registration shall be a first degree misdemeanor.
• $75.00 Annual Rental Registration Fee per owner or agent in charge if filed between January 1 and March 31
• $35.00 Rental Registration Update Fee. This includes if a property owner acquires or agent in charge takes
charge of additional rental units during a calendar year.
RESIDENTIAL TENANT INFORMATION FORM
Building Department
T
he following information is necessary of tax, health, and safety purposes. Please complete and submit one sheet per
property listed on the previous page.
Tenant Information
Property Address: ________________________________________________________________________________
Primary Tenant’s Name: ___________________________________________________________________________
Telephone Number: ____________________________ E-mail Address: ____________________________________
Name of Tenant 2: _______________________________________________________________________________
Name of Tenant 3: _______________________________________________________________________________
Name of Tenant 4: _______________________________________________________________________________
Name of Tenant 5: _______________________________________________________________________________
Name of Tenant 6: _______________________________________________________________________________
Name of Tenant 7: _______________________________________________________________________________
Name of Tenant 8: _______________________________________________________________________________
Names:
_______ - _______ - ___________ __________________ __________ ___________________
Primary Social Security Number First Name Middle Last Name
_______ - _______ - ___________ __________________ _________ ___________________
Spouse’s Social Security Number First Name Middle Last Name
Primary date of birth: ______ / ______ /_____ Spouse’s date of birth: ______ / ______ /_____
Registration for the city or village of: __________________________
Current Residence Address Information:
__________ _________________________________ __________ ____________
Street No. Street Name Apt. /Suite # PO Box
_____________________________________ _________ ___________
City / Village State Zip Code
Date you moved to this address: ______ / ______ /_____ Contact Phone No. (______) ______ - ________
Do you own or rent your home? (Please check one) Own _____ Rent _____
If renting please give the Landlord’s name, address and phone number ___________________________________
_____________________________________________________________________________________________
Previous Residence Address Information:
__________ ____________________ __________ ___________________ ________ ___________
Street No. Street Name Apt. /Suite # City / Village State Zip Code
Date you moved to this address: ______ / _______ / _____
Employment Information: (Check Yes or No, if retired please include date of retirement)
Are you employed? Yes ____ No ____ Is your spouse employed? Yes ____ No ____
Are you retired and/or have no taxable income? Yes ____No ___ If Yes, date you retired: _____/_____/_____
Is your spouse retired and/or have no taxable income? Yes ___ No ____If Yes, date your spouse retired: _____/_____/______
Do you have income reported on Federal Schedules C, E or F? Yes ____ No ____
Does your spouse have income reported on Federal Schedules C, E or F? Yes ____ No ____
Do you and/or your spouse own rental property? Yes ____ No ____ (Please list tenant’s name, address and date you began
renting property. If you have multiple properties, please supply additional information on back or a separate sheet of paper.)
Tenant’s First, Last Name and address: ___________________________________________________________
______________________________________________________________ Date: ______ / ______ / ______
Mail form to: RITA
ATTN: Registration Dept.
P.O. Box 477900
Broadview Heights, OH 44147-7900
Call: 800.860.7482, ext. 5008
FAX
form to: 440.526.3136
Regional Income Tax Agency
Individual Registration Form
FORM
75
Business Type Reason for Registration
Corporation
Non-Profit
S-Corp Estate & Trust Doing business within the municipality this year (temporary)
LLC
Sole Proprietor / LLC Approx. # of days Start Date
Partnership
Business with a fixed location
Company Information
(List physical address of work performed within this municipality)
Name: Federal ID #:
Address:
SSN :
City/State/Zip:
Mailing Address
(for withholding tax forms / if different from above)
Mailing Address
(for net profit tax forms / if different from above)
Filing Status:
Calendar year Fiscal year / month ending
Do you have any employees? Yes No
Number of employees at RITA location
My withholding is filed under a 3rd party account (PEO or common paymaster)
Monthly gross payroll at RITA location $
I am a small employer (under $500,000 in gross revenue during previous year)
Contractors
I am a contractor Yes No
Will you be using sub-contractors?
Total contract amount of the project $
The Information Hereby Submitted is True and Correct.
Phone Number
/ /
*Please note that your Federal Identification Number will serve as your RITA account number.
Municipality
Date business began at this location
(required if sole proprietor)
Yes
No
If yes, list Federal ID #
Yes
No
Yes
No
If yes, complete page 2.
Print Name
Title
Date
Please complete and sign this Registration Form and return within 10 business days. Please be advised that failure to timely register with RITA may result in delays in the
processing of any required income tax filings or may result in future penalty and interest charges, if applicable. If you have any questions please contact the Registration
Department at the number below.
Signature
ritaohio.com
Call: 800.860.7482, ext. 5008
TDD: 440.526.5332
Fax: 440.922.3536
Mail to: RITA
ATTN: BUSINESS REGISTRATION
P.O. BOX 477900
BROADVIEW HEIGHTS, OH 44147-7900
FORM
48
Regional Income Tax Agency
Business Registration Form
Access ritaohio.com to register electronically using MyAccount. Login to
MyAccount to Add a Municipality or Add Subcontractor. These features allow
you to report a new location or new subcontractor project electronically.
PRINT FORM
RESET FORM
$
$
$
$
$
EIN or Social Security #
Trade
Sub-contractor Name / Address
Contact Name
Contract Amount
Phone Number
Estimated Start Date
EIN or Social Security #
Trade
Sub-contractor Name / Address
Contact Name
Contract Amount
Phone Number
Estimated Start Date
EIN or Social Security #
Trade
Sub-contractor Name / Address
Contact Name
Contract Amount
Phone Number
Estimated Start Date
EIN or Social Security #
Trade
Sub-contractor Name / Address
Contact Name
Contract Amount
Phone Number
Estimated Start Date
EIN or Social Security #
Trade
Sub-contractor Name / Address
Contact Name
Contract Amount
Phone Number
Estimated Start Date
Sub-contractor Name / Address
$
Contact Name
Contract Amount
Phone Number
Estimated Start Date
EIN or Social Security #
Trade
*If more space is needed, you may attach a separate schedule that includes ALL of the required information listed above.
Mail to: RITA
ATTN: BUSINESS REGISTRATION
P.O. BOX 477900
BROADVIEW HEIGHTS, OH 44147-7900
Call: 800.860.7482, ext. 5008
TDD: 440.526.5332
Fax: 440.922.3536
ritaohio.com