RECEIVED
Stamp RACE CLERKS OFFICE
CITY OF RICHMOND Kirkuma
2023 MAR 17 PM 4: 05
RENT BOARD APPLICATION FORM
3|17/2023
DATE:
Check one: New Appointment
Re-Appointment -
Jin Hite
NAME:
HOME ADDRESS: E-MAIL ADDRESS LATOICH
ZIP CODE 14801 I VIT WORK PHONE:
HOME PHONE:
OCCUPATION: _ STUDeNT
HOWLONG HAVE YOU BEEN A RESIDENT OF THE CITY OF RICHMOND: 23 4C4CS PLACE OF EMPLOYMENT: Berkeley City College
REASONS FOR INTEREST IN APPOINTMENT. DUTY Former member of the PMAC Pan More CitIZEnS ADUOr Commitile D
poirt Molate
EDUCATION:
some unirsiry, cots o community collere.
REFERENCES (Minimum 3.- List Name, Address, Phone Number, and Email Address) los
2. 3.
4. To the best of my knowledge the information provided is true and correct:
Signature Date 3/16/23
Deliver or Mail to: City Clerk, 450 Civic Center Plaza, Suite 300, Richmond, GA 94804 OR Email to: [email protected] For Office Use Only: New Appointment: Reappointment: • 1st • 2nd • 3rd Rev: 2 (8/17/2020)
RENT BOARD APPLICATION FORM
The following restrictions and requirements for Rent Board members are in the Richmond Fair Rent, Just Cause for Eviction, and Homeowner Protection Ordinance:
11.100.060(b): Eligibility. Duly qualified residents of the City of Richmond are eligible to serve as Members of the Board. There shall be no more than two members that own or manage any rental property or who are realtors. Anyone nominated to this board must be in compliance with this Chapter and all other local, state, and federal laws regulating the provision of housing.
11.100.06(c): Full Disclosure of Holdings. Nominees for the position of Board Member shall submit a verified statement listing all their interests and dealings in real property, including but not limited to its ownership, sale or management during the previous three (3) years. The Board may promulgate additional regulations.
In order to determine your eligibility, please complete the requested information below under ELIGIBILITY AND DISCLOSURE OF HOLDINGS, listing your interests and dealings in real property, including but not limited to its ownership, sale or management during the previous three (3) years. If you have owned, sold, or managed real property in the last three years, you do not have to provide any details other than the address of the properties owned, rented out or managed, or the name of the brokerage business.
If appointed to the Rent Board, you may be required to submit a Form 700 - Statement of Economic Interest.
Eligibility and Disclosure of Holdings
I, JIM HITE _(print name), submit this as a verified statement of interest and eligibility in accordance with my application to the Rent Board established in the City of Richmond under the Richmond Fair Rent, Just Cause for Eviction, and Homeowner Protection Ordinance.
Answer yes or no to the following statements:
I have owned, sold, or managed real property in the last three (3) years. If yes, please include a full list of interests and dealings, including addresses of properties owned, sold or managed during the previous three (3) years.
Yes / (No)
l am a realtor * Yes / (No
I own or manage rental property.** ves / (No
* Note: The term "realtor" includes anyone who is professionally involved in brokering real estate sales, rentals or leases, not just members of the National Association of Realtors. **Note: The term "rental property" includes both residential and commercial property.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. LeNite 3/16/23
Signature Date