East Chicago Building Department Honorable Anthony Copeland, Mayor Winna G. Guzman, Building Commissioner wguzman@eastchicago.com 2015 Rental Registration Form Pursuant to Ordinance No.09-0020 and Code of Ordinances Title XI, Chapter 123 of the City of East Chicago, any and all rental housing must be registered with the Building Department on an annual basis. Please complete this form, and return to the East Chicago Building Department along with the rental registration fee of $10.00 (check or money order only) per each dwelling or rooming unit. A late fee shall be assessed in the amount $100 for each dwelling or rental unit not registered by April 15th. For additional information, please contact the East Chicago Building Department at (219) 391-8294 or visit the City s website at www.eastchicago.com (Building link). Please complete one application for each rental housing address [please print]. 1. Rental property address Sticker # 2. Permanent real estate key number [printed on real estate tax bill] 3. Total number of rental units within building Also, list the names, address and telephone numbers of all other owners, agents, or mortgage holders of the building. 4. Owner(s) [if additional owners, go to #22] 5. Address 6. Telephone No. City State Emergency Contact No. Zip Code Email 7. Managing agent [must reside or maintain office in Lake County, Indiana] 8. Address City 1
9. State Zip Code Telephone No. Emergency Contact No. 10. Primary contact person 11. Address City 12. State Zip Code Telephone No. Emergency Contact No. 13. Trust Beneficiary 14. Address City 15. State Zip Code Telephone No. 16. Corporation or partnership [officer/partner s name and title] 17. Address City 18. State Zip Code Telephone No. 19. Mortgage holder Account No. 20. Address City 21. State Zip Code Telephone No. 22. Additional owner(s) [for more owners, please list on separate sheet] 23. Address City 2
24. State Zip Code Telephone No. Emergency Contact No. 25. Insurance company [proof of insurance must be submitted] 26. Address City 27. State Zip Code Telephone No. 28. Policy No Expiration Date Please attach a copy of your insurance policy. 29. Tenant/occupant information [as tenants change, you are required to submit updated information] 1 2 3 4 5 6 7 8 9 10 Occupant Information Unit First Last Telephone Total Total OFFICE USE No. Name Name No. Occupants Bedrooms Sticker # Date Basement Apartment: YES NO Attic Apartment: YES NO I affirm that all information provided above is true and accurate to the best of my knowledge. Falsification of this application will result in registration certificate being null and void. I attest that the above-referenced property is equipped with approved, and operating fire/smoke and carbon monoxide detectors, pursuant to East Chicago Municipal Code of Ordinances, Title IX: General Regulations, Chapter 92: Fire Prevention. Signature Date Please Print 3
I,, property owner, being neither a minor nor incompetent swear and affirm under the penalties of perjury the following: I am the legal owner of the property located at:, Apartment No.:, East Chicago, IN 46312. I hereby do make application for a special exemption from the Rental Registration Requirements for the following reasons: Check all that apply Property listed above is currently occupied by an immediate family member. Property listed above is currently occupied by owner of record. Name: Relationship I hereby agree to furnish all necessary documentation as required to verify I am entitled to this exemption. Falsification of this document or failure to provide documentation will result in automatic denial of exemption and all applicable penalties may apply. Signed and sworn this day of, 2015. Signature Property owner information: (bottom portion must be completely filled out) Complete Mailing Address: Phone Number: Alternate Phone Number:
East Chicago Building Department Division of Inspections & Permits/Code Enforcement 4444 Railroad Avenue, East Chicago, IN 46312 (219) 391-8294 ~ Fax: 391-7013 www.eastchicago.com REQUIREMENTS FOR RENTAL PROPERTY REGISTRATION Pursuant to City of East Chicago, Indiana Code of Ordinances Title XI, Chapter 123: Rental Housing and Ordinance No. 09-002017, owners of real property in the City of East Chicago which real property is used as rental housing shall be required to register all such properties on an annual basis, by April 15 th of each year or within 30 days of obtaining title to rental housing real property. Payment must be made by Check or Money Order only. 1. Registration Forms Registration forms are available at the East Chicago Building Department Office, 4444 Railroad Avenue, East Chicago, Indiana, and to be completed by the owners, or his representative, of real property used as rental housing. 2. Registration Fee Registration fee shall consist of a $10 per each dwelling or rooming unit (occupied or vacant and unless occupied by owner or immediate family member). There shall be a $100 late fee assessed for each dwelling or rental/rooming unit not registered by April 15 th of every year. 3. Proof of Ownership Proof of ownership, i.e. deed, mortgage, etc., shall be required to be presented upon owners registering their rental properties. In addition, picture identification, i.e. driver s license or state identification, shall be required. 4. Proof of Insurance (**Declaration Page showing insurance coverage amounts) Proof of property insurance shall be submitted upon owners registering their rental properties. Alternately, a bond or letter of credit from a federally insured financial institution may be filed with the Office of the City Controller in an amount equal to the value of the property insured or $25,000, whichever is greater, which will be used to cover the cost of demolition if necessary. 5. Occupant Information Each applicant for rental registration shall, in addition to all other information required, provide the names of the primary tenants for each rental unit and an emergency contact number for each listed tenant. 6. Violation Failure to register any and all real property utilized as rental housing shall constitute a violation of this chapter and the owner shall be assessed a fine not to exceed $2,500 per unit. For additional information, please contact the East Chicago Building Department at (219) 391-8294 or visit the City s website at www.eastchicago.com (Building link).