RENTAL TAX APPLICATION/CERTIFICATE OF USE

Transcription

1 Development Services Department 401 Clematis Street West Palm Beach Florida Phone: RENTAL TAX #: RENTAL TAX APPLICATION/CERTIFICATE OF USE PCN #: digit Parcel Control Number can be found on Palm Beach County Property Appraiser (PAPA) website at: OWNER NAME: The Owner name as it appears on Palm Beach County Property Appraiser (PAPA). Copy of Bill of Sale/Recorded Warranty Deed/Settlement Documents from Closing required for recently purchased property. If the Owner name is a corporation, partnership, LLC, or fictitious name please provide proof from Division of Corporations (Sunbiz) official website: FEIN#: OR SS#: OR ITIN#: Federal Employee Identification Number Social Security # Required FS (5) Individual Taxpayer Id Number RENTAL ADDRESS: APT #: CITY: STATE: ZIP: CONTACT PERSON: PHONE: MAILING ADDRESS: APT #: CITY: STATE: ZIP: *VACATION RENTAL SHORT-TERM YES NO If yes, must provide proof of your State of Florida Vacation Rental license. *Vacation rental short-term means any dwelling unit or structure originally constructed for residential use that is used for temporary lodging and is listed with an agent, advertised or made available by referral, word of mouth, Internet, recommendation and/or reputation as a vacation or tourist rental and rented or made available for rent for a minimum of 7 consecutive days. FOR OFFICIAL USE ONLY ASSISTED BY: DATE STAMP: CATEGORY: Rental Application: Page 1 of 2 Rev. 01/24/17 "An Equal Opportunity Employer"

2 FEE SCHEDULE AND DEPARTMENTAL APPROVAL RENTAL PROPERTY TYPE: SINGLE FAMILY/TOWNHOUSE/CONDO #: X = $ GARAGE APARTMENT(S) #: X = $ APARTMENT(S) #: X = $ INSPECTIONS: ZONING FEE (SINGLE UNIT) $10.00 ZONING FEE (MULTIPLE UNITS) $20.00 $ $ CODE ENFORCEMENT FEE $20.00 $ FIRE INSPECTION FEE *Inspection only for 3 or more units under the same roof. No fire inspection for condos. $35.00 (3-11 UNITS) $ $55.00 (12-24 UNITS) $ $75.00 ( UNITS) $ $ (OVER 100 UNITS) $ CERTIFICATE OF USE (COU) FEE: $50.00 $ % penalty is collected on all notice of violations $ TOTAL $ NAME CHANGE ONLY: $25.00+COU $50 $ *No inspections on name change I CERTIFY THAT ALL THE ABOVE INFORMATION IS TRUE AND CORRECT, AND I UNDERSTAND THAT ANY FALSE STATEMENTS CONSTITUTE A VIOLATION OF FLORIDA STATE STATUTES AND WILL RESULT IN THE REVOCATION OR DENIAL OF CERTIFICATE OF USE AND PROSECUTION IN ACCORDANCE WITH THE LAW. I HEREBY AGREE TO OPERATE THE ABOVE DESCRIBED PROPERTY IN ACCORDANCE WITH ALL THE LAWS OF THE STATE OF FLORIDA AND THE LAWS AND ORDINANCES OF THE CITY OF WEST PALM BEACH. I ACKNOWLEDGE THE CITY OF WEST PALM BEACH ORDINANCE NO SECTION , RELATING TO THE REGULATION OF THE RESIDENCY OF SEXUAL OFFENDERS AND SEXUAL PREDATORS. FURTHERMORE, I UNDERSTAND THAT THE ISSUANCE OF THIS LICENSE IS CONDITIONED UPON THE COMPLIANCE WITH ALL ORDINANCES AND THE RESULTS OF ANY INVESTIGATIONS OF THE ABOVE DESCRIBED PROPERTY. I ACKNOWLEDGE THAT THE RENTAL TAX RECEIPT EXPIRES EACH YEAR ON SEPTEMBER 30 TH. OWNER S SIGNATURE: DATE: PRINT NAME: SIGNATURES MUST BE ORIGINAL. APPLICATION MAY NOT BE FAXED. RETURN APPLICATION BY MAIL OR IN PERSON TO DEVELOPMENT SERVICES AT 401 CLEMATIS STREET WEST PALM BEACH FLORIDA Rental Application: Page 2 of 2 Rev. 01/24/17 "An Equal Opportunity Employer"

3 On July 28, 2008, the City of West Palm Beach adopted Ordinance No , an ordinance relating to the regulation of the residency of sexual offenders and sexual predators within the City if West Palm Beach. The subject ordinance prohibits sexual offenders and sexual predators from residing within fifteen hundred (1,500) feet of any school, designated school bus stop, child care facility, park, playground, community center, or other place where children congregate, and is applicable to all dwelling units located within the city. Specifically, Section of this ordinance prohibits a landlord or owner of a residential property in the city that is located within fifteen hundred (1,500) feet of any school, designated school bus stop, child care facility, park, playground, or community center, or other place where children congregate from permanently or temporarily letting or renting a residence to any sexual offender or sexual predator, and allows for the imposition of a civil fine against a landlord or owner of residential property in the city for a violation of the City s Ordinance. The provisions of the City s ordinance are not applicable to persons residing at a prohibited location on the effective date of this article. The provisions of this article do apply upon termination of any leasehold relationship arising from a landlord-tenant relationship or the expiration of a lease. Additionally, the Code of Ordinances sets forth that a landlord or owner of residential property who rents dwelling units located within the city that are located within fifteen hundred (1,500) feet of any school, designated school bus stop, child care facility, park, playground, community center, or other place where children congregate must obtain an affidavit from the tenant that they, or the people who reside with them, are not registered sexual offenders or sexual predators, and must make a good faith effort to confirm that a prospective tenant is not registered as a sexual offender or sexual predator. The following websites are available for a landlord or owner of residential property to confirm a proposed tenant is not registered sexual offender or predator: Alternatively, you may contact the City of West Palm Beach Police Department Detective Division directly at (561) Such actions shall continue good faith compliance with the City s ordinance, even if it is ultimately determined that a sexual predator or sexual offender did reside in their rental unit.

4 Development Services City Center Clematis Street, 1st Floor West Palm Beach, FL Acknowledgement of Landlord/Property Owner I,, landlord/property owner, have received an affidavit from the prospective tenant (s), that no residents of the rented dwelling are registered as a sexual offender or a sexual predator. I,, landlord/property owner, have reviewed the up-to-date list of sexual offenders and sexual predators, or have conferred with the West Palm Beach Police Department, and have determined that the prospective tenant or tenants are not included on the list. I,, landlord/property owner, acknowledge that the requirements of Chapter 54, Article xii. of the City Code relating to sexual offenders or sexual predators shall apply upon termination of any leasehold relationship arising from a landlordtenant relationship, or the expiration of a lease, or when an offender or predator changes residence. ADDRESS: Name of Landlord/Property Owner (Printed): Signature of Landlord/Property Owner: STATE OF FLORIDA COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me day of 2015, by who is personally known to me or who has produced as identification and who did/did not take an oath. Notary Public Signature Notary Public Printed Name

5 SEXUAL OFFENDER/PREDATOR AFFIDAVIT AFFIDAVIT REGARDING SEXUAL PREDATOR / SEXUALLY VIOLENT PREDATOR / SEXUAL OFFENDER RESIDENCY REQUIREMENTS OF THE CITY OF WEST PALM BEACH STATE OF FLORIDA) COUNTY OF PALM BEACH) Before me personally appeared (print name of tenant), who states on oath, and, upon personal knowledge the following: 1. I hereby acknowledge that I have read and understand the Code of Ordinances of the City of West Palm Beach, Section (Sexual offender and sexual predator residence prohibition). 2. I hereby acknowledge and understand that it is unlawful for any person who has been convicted of a violation of F.S , , , or , or any amendments thereto, regardless of whether adjudication has been withheld, in which the victim of the offense was less than 16 years of age, or any person who is designated as a sexual predator, sexually violent predator or sexual offender in another state or jurisdiction subject to registration or community notification under Florida law, to establish a permanent residence or temporary residence within 1,500 feet of any school, designated school bus stop, child care facility, park, playground, community center, or other place where children regularly congregate. 3. Check one of the following: I am not a registered sexual predator, sexually violent predator or sexual offender as defined in Sec I am a registered sexual predator, sexually violent predator or sexual offender as defined in Sec , but I fall within one of the exceptions outlined in Sec (c)(1)-(5). [List specific exception here: ]. Date Tenant (signature) Tenant (print name) Sworn to and subscribed before me this day of, 20, by, who is personally known to me or who provided a photo ID to me. My Commission Expires: Notary Public, State of Florida Notary Public Signature Notary Public Printed Name