City of Tempe
Residential Rental Property
Supplemental Form
Licensee Name __________________________________
Street Address
Ste/Apt #
Zip
Date Acquired
Type
(House/Duplex/C
ondo)
1
2
3
4
5
If necessary, please use additional pages to list property.
Taxpayer Signature __________________________________________
Date __________________
Taxpayer Name _____________________________________________
Phone # ________________________
For Office Use Only:
Parcel ID #
1
2
3
4
5
The Tempe Zoning & Development Code limits a household in a single-family-residential district to: [a] one person, or [b] a
family plus two additional persons, or [c] no more than three unrelated persons. See Tempe Z & D Code Section Section 2-107
for maps that identify single-family-residential districts. See Sections 3-102 and 7-107 for a complete definition of permitted
household occupancy in single-family-residential districts.
J:\Rental housing change\Res Rental Supplemental.xls
06/11/2008
Check any
that apply:
New Business
New Owner of Existing Business
Former Owner (if applicable)
Previous City License #
Name Change Only
Location Change
Current City License #
Date of Change
SECTION I. BUSINESS INFORMATION
Start Date
E-mail address
$50 $25 $10
SECTION II. MAILING ADDRESS & PHONE NUMBER
$70 $45 $30
SECTION III. BUSINESS OWNERSHIP & RECORD LOCATION
Individual LLC Corp. - State Inc.______ Gen. Partnership Ltd. Partnership Other _____________
Name
Social Security #
Home Address
Title
City
State
ZIP Code
Phone No.
( )
Name
Social Security #
Home Address
Title
City
State
ZIP Code
Phone No.
( )
Corporate or LLC
Statutory Agent
Name
Phone No.
( )
Name
Phone No.
( )
Address
City
State
ZIP Code
SECTION IV. BUSINESS TYPE
Retail Sales Wholesaler