4112 Skylark Lane - Rental Registration
CERTIFICATE OF RENTAL REGISTRATION
This certificate verifies that the below property is registered as a residential rental
Sarah Brandel, Office Supervisor
Department of Community Development
1
Number of Units:
City of Eagan
Signed:
55402
property within the City of Eagan.
Skylark Lane
212
55122
MN
JM Condo, LLC
S 7th Street
,
Minneapolis
Justin Berg
MN
,
Eagan
4112
22, 2016
40
Property Owner:Manager:
January
Site Address:
Rental
Date:
Au2 grtyka'04 W19-,
ft of Eakan
3830 Pilot Knob Road
Eagan MN 65122
Phone: (651) 676.5660
Fax: (651) 675-504
Email: commdevelopmenio-)cityofeaQan.com
RESIDENTIAL RENTAL REGISTRATION
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Either a property owner or rental manager shall register all residential rental properties with the City of Fagan. In the case of
a transfer of ownership, change in rental manager, change in the number of rental units or change in dwelling occupancy
from owner occupancy to rental tenant occupancy, the property owner or rental property manager shall complete and submit
a registration form for every property affected by the transfer within thirty (30) days of the transfer.
Please complete one registration form for each residential rental property address.
Check one of the following that applies:
XNew Rental Registration
❑ Change of addressiphone number
❑ Change of owner
APPLICANT/
REGISTRANT
(person
completing fonn)
Name:
❑ Change of rental manager
❑ Change in number of units
❑ Change from owner to rental occupancy
Address NumbedStreet `I , 5� it t , PM 17 ?, I
City AAi n ea p f > `S -- state: AA h5 zip: 2
Primary Prone: (0 f s Altemate Phone:
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Email: i 0
Jeati k --c/ z- . e o
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RENTAL Address Number. �I Street 4f Tip: t
PROPERTY
INFORMATION
Number of Rental Units: Building Name {if applicable):
Name: t1 r " \ o ei do . i� Ir - --•• --- • — •—
Address Number/Street 0 / y', tc
PROPERTY k
OWNER City: &JInidetl D0115, State: zip:
r C
Primary Phone: l � t � � ` 1 �� � Alternate Phone:
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[_mall: t bev-eio de-ao Wet ;�- b 6evI o
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4112 Nu�{a,(K lsJA.Q,
A rental manager is required. A rental manager is any person who has been delegated by the
residential rental property owner with the charge, care or control of a residentlai rental property and
is able to respond in-person to issues related to the residential rental property_ The rental manager
may be the same as the owner and/or applicant.
Name: . i 0.5j tf ki
RENTAL
MANAGER ,address Number/Street
QUESTIONS
a 5, `7 '' - , �<U I't-l—, 6e� ) a , P11,B ,210
City: M f}k1 k7 &4 0 D�!`S State: zip:. -55 -J --
Primary Phone &SI) q55 -1s, + Alternate Phone:
► ig �
Email t- U S ' , rt 1 d e Otl P v -C 12 , G yr
Any person providing false .information on the prescribed registration form shall be guilty of a
misdemeanor and subject to a fine. The responses are being collected for informational purposes and a
`yes' answer is not required.
9. Does the residential property owner or rental manager conduct a criminal background check on
each and every residential tenant?
X Yes 0 No
2.oes a written lease exist for each and every residential property and unit dweliing thereon?
psYes 1] No
3. Does a written lease addendum commonly known as "Drug Free/Crime Free Lease Addendum"
exist for each and every written lease?
X Yes Cl No
After completing the Residential Rental Registration form in its endrety, submit it electronically to
commdevelopmentD-crtyofeartan.com, fax to (651) 6754694 or deliver to:
Eagan City Hall
Attn: Community Development
3830 Pilot Knob Road
Eagan, MN 55122
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