GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS BUSINESS REGULATION ADMINISTRATION ONE STOP BUSINESS CENTER 941 NORTH CAPITOL STREET, N.E., ROOM #1100 WASHINGTON, D.C. 20002 (202) 442-8957 APPLICATION AND INSTRUCTIONS FOR A COOPERATIVE HOUSING ASSOCIATION LICENSE Please read and follow these instructions carefully. A complete and correct application will expedite the issuance of your license. Application/Processing Requirements: 1. A completed Miscellaneous application (BRA-4) is required. (attached) 2. Each Corporation, Limited Liability Company, or a Limited Partnership doing business in the District of Columbia must be in good standing. For additional information, please call (202) 442-4430, or visit the One Stop Business Center located on the 1st Floor, Room #1100. 3. A Certificate of Occupancy is required for the use of commercial space in the District of Columbia. For additional information, please call (202) 442-4567, or visit the Permit Information & Issuance Branch on the 2nd Floor, Room #2300. 4. A Tax Registration Certificate is required from the Office of Tax and Revenue. For additional information, please call (202) 727-4829, or visit the Tax Customer Center located on the 1st Floor, Room #1110. 5. A Certified Resident Agent Appointment Form is required for all applicants who are non-residents of the District of Columbia. (attached) 6. The annual license fee is fourteen dollars ($14.00). American LegalNet, Inc. www.USCourtForms.com DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS CERTIFICATION TO THE APPLICANT: PLEASE READ CAREFULLY AND COMPLETELY BEFORE SIGNING. A FALSE STATEMENT ON THIS CERTIFICATION REQUIRES THAT THE DEPARTMENT PROCEED IMMEDIATELY TO REVOKE THE LICENSE OR PERMIT FOR WHICH YOU ARE NOW APPLYING, AND FINE YOU $1,000.00. THIS CERTIFICATION IS REQUIRED BY THE “CLEAN HANDS BEFORE RECEIVING A LICENSE OR PERMIT ACT OF 1996,” (EFFECTIVE MAY 11, 1996, D.C. LAW 11-118, D.C. CODE § 47-2861 et seq.). I, _____________________________________, certify that as of __________________________, I do not Print Name Clearly Date owe more than $100.00 to the District of Columbia government as a result of: 1. Fines, penalties or interest assessed pursuant to the Litter Control Administration Action of 1985, effective March 25, 1986 (D.C. Law 6-100; D.C. Code § 6-2901 et seq.); 2. Fines, penalties or interest assessed pursuant to the Illegal Dumping Enforcement Act of 1994, effective May 20, 1994 (D.C. Law 10-117; D.C. Code § 6-2911 et seq.); 3. Fines, penalties or interest assessed pursuant to the Department of Consumer and Regulatory Affairs Civil Infractions Act of 1985, effective October 5, 1986 (D.C. Law 6-42; D.C. Code § 6-2701 et seq.); or 4. Past due taxes. I understand that if I knowingly falsify this Certification, the Department will move to revoke the license or permit for which I am applying, and to fine me $1,000.00. I further understand that the Department may conduct an investigation to ascertain the veracity of this certification. I understand that this Certification is now required as documentation to accompany my application for a license or permit, and that by completing this Certification, I am not guaranteed that my license or permit will be approved. __________________________________________ SIGNATURE OF APPLICANT __________________________________________ TITLE American LegalNet, Inc. www.USCourtForms.com GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS BUSINESS REGULATION ADMINISTRATION ONE STOP BUSINESS CENTER CERTIFIED RESIDENT AGENT APPOINTMENT FORM A non-resident of the District of Columbia who wishes to transact business in the District of Columbia shall appoint a Resident Agency or an Attorney-in-Fact who resides or who maintains an office in the District of Columbia upon whom, all fiducial and other process or legal notice directed to the applicant may be served upon the appointed Resident Agent. I, ____________________________________________________________________________hereby appoint (Owner/Proprietor) for __________________________________________ ____________________________________________ (Name) (Address) ________________________________________ as my resident agent for all fiducial and other process or legal (Telephone Number) notice directed to the applicant shall be served. I certify that the applicant and the applicant’s principal officers are fit, willing and able to conduct the business of ____________________________________________________ in the District of Columbia and promises to comply with all laws and regulations concerning the requested business type. ____________________________________ Resident Agent ____________________________________ Owner/Proprietor The information above is subscribed and sworn to before me, a Notary Public this __________________day of ______________ 20________. SEAL Notary Public ___________________________________ Commission Expires ______________________________ American LegalNet, Inc. www.USCourtForms.com GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS BUSINESS REGULATION ADMINISTRATION Business Service Division, Room 100, 614 H Street, N.W. Washington, D.C. 20001 GOVERNMENT OF THE DISTRICT OF COLUMBIA BRA-4 (3/97) APPLICATION FOR D.C. LICENSE (PLEASE PRINT IN INK OR TYPE) TYPE OF LICENSE OFFICIAL USE ONLY Housing FOR PERIOD FROM __________________TO ________________ CUSTOMER NO: AUDIT # CATEGORY NO: FEE: $ For Office Use Only PLEASE READ INSTRUCTIONS 1. Name of Applicant (If Corporation or Partnership, Complete Box at Right) 3. Trade Name of Business, If Any 2. Partnership or Incorporating Information Check Partnership Corporation List Partners or Officers President or Partner 4. Billing Name Vice President CORP. DIV. 5. Billing Address Zip Secretary or Partner 6. Home Address of Applicant Treasurer or Partner 7. Corporation and Non-D.C. Resident Applicant’s Agent Other Name: 8. Signature of Agent to Receive Notices ZONING Address: 9. Telephone Number State of Incorporation Year 10. Owner of Building Name: Name: 11. Address of Premises Applied for A APT. Address: 12. D.C. Ward# No. of Apartments No. Effc. 1-Br. 2-Br. 3-Br. of B Rental Accommodations Registration Number _________________________________________ RAO C ROOMING HOUSE 13. Certificate of Occupancy No. No. of Sleeping Accommodations Will you offer Available (double bed counts as 2) _________________ meals to tenants? ___________________________________________ D E MOTEL No. of Rooms _________________ F HOTEL No. of Rooms ______________ No. of Kitchens _________________ Name Date of Birth MANAGER Residence Address 14. Signature of Applicant Penalties for False Information 15. Date of Birth DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS BUSINESS REGULATION ADMINISTRATION BILL ONLY Business Service Division, Room 100, 614 H Street, N.W. (This is not a license) Washington, D.C. 20001 16. Telephone No. GOVERNMENT OF THE DISTRICT OF COLUMBIA BRA-4 (3/97) Hampton Cross, Director NOTE: It is unlawful to operate before a license is actually issued and to do so will render you subject to criminal prosecution. OFFICE USE ONLY This bill for Type of License, Applicant’s Name and Address for Period From: which applied (If corporation Use corporate Name) $ CIG. 1225 To: $ RAO 1234 $ 1211 $ LATE FEE Party Billed and Mailing Address CUSTOMER # PAY THIS AMOUNT PAYABLE TO THE D.C. TREASURER TOTAL NOTE: PUBLIC LAW 89-208 REQUIRES A CHARGE OF $50.00 FOR DISHONORED CHECKS HAVE YOU COMPLETED ALL ITEMS? This space for use of the D.C. Treasurer only Telephone No. American LegalNet, Inc. www.USCourtForms.com