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2. 
4. Property Address*
6. Please select one:*

   1. This property has been sold.
   2. This property is not being rented.
   3. This property is occupied by the owner or the owner's *qualifying relatives.
   4. This property is rented for less than 120 consecutive days, and the owner occupies it during the remainder of the year.
   5. This property operates as a Minnesota Department of Health-licensed rest home, convalescent care facility, group home, nursing home, hotel, motel, or cooperative.
   6. This property operates as a facility for which a reasonable accommodation has been granted by the city under the Federal Fair Housing Amendments Act of 1988.
   7. This residential dwelling is located on property exempt under MN §272.02 and is used only by the tax-exempt owner as housing for its clergy members.

   
   

   * Applies if all renters are related to the owner (by blood or marriage) as a parent, stepparent, child, stepchild, grandparent, grandchild, brother, sister, uncle, aunt, nephew, or niece.

10. Corporate Owner Name (if applicable)
12. Name of Property Owner/Partner/Corporate Officer*
13. Date*
    Date
15. By submitting this form, I affirm that I have read and understood the statements above and that, to the best of my knowledge, they are true and accurate. I acknowledge that I am the individual identified as the owner on this form, and I am submitting this declaration in that capacity. I understand that submission of false or misleading information may be subject to penalties under applicable laws or ordinances. I further understand that if the property becomes a rental and is not exempt from licensure at any time, I am required to obtain a rental license in accordance with Maplewood City Code, Chapter 12, Article XIII.
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