HomeMy WebLinkAboutInformational Disclosure and Acknowledgement Form
CITY OF IOWA CITY
INFORMATIONAL DISCLOSURE AND ACKNOWLEDGMENT FORM
City of Iowa City, 410 E. Washington Street, Iowa City, IA 52240
Call Housing and Inspection Services for questions at (319) 356-5130
www.icgov.org/housing
Note: All information must be entered on form. “SEE LEASE” entries are not acceptable.
1. Unit Address: ________________________________________________________________
2. City Website. The website for the City of Iowa City is www.icgov.org and it provides extensive information about the City of
Iowa City and its services. To access information concerning the Department of Housing and Inspection Services, including
the Rental Housing Inspection Division, go to www.icgov.org/housing. To access the City Code, click on
www.icgov.org/citycode.
3. Occupancy. The maximum occupants/tenants for this unit are ___ unrelated persons. Maximum occupancy is available on
the Housing and Inspection Services web page on the City website at the link entitled "rental permit" (http://www.iowa-
city.org/icgov/apps/gen/rentals.asp). Nothing in this document prevents the owner or operator from limiting the number of
tenants to less than the maximum allowable occupancy permitted by the City Code.
4. Tenants. The names of the tenants, including those under 18 years of age, who may occupy this unit:
Name of Tenant Name of Tenant
______________________ ______________________
______________________ ______________________
______________________ ______________________
5. Fines. The undersigned acknowledge that we are responsible for complying with the maximum occupancy limits of the City
Code and that the City Code provides that violation of the maximum occupancy limit can result in a $750.00 fine for the first
violation (the City Code also provides that each day is considered a new violation) to the owner, operator, and/or tenant.
6. Sleeping Rooms. Basements, attics, and other rooms cannot be used as sleeping rooms if they do not comply with
requirements for windows, exits, square footage, and other Housing Code requirements.
Basement is: ☐Habitable ☐Non-Habitable
Attic is: ☐Habitable ☐Non-Habitable
7. Trash/Recycling. Complete this only if this unit has four (4) dwelling units or less. Trash and recycling pickup for this unit is
____________ (day of the week). City Code section 16-3H-9D provides that garbage receptacles can be brought to the curb
after 3 PM the day before pickup and must be brought back to the property on the same day as collection. If the City has
provided a “refuse cart” (i.e., City garbage can) it must be used. If the City has not provided a “refuse cart” each unit can
place up to two 35-gallons containers for pickup, and the containers must be stored (when not at the curb for collection) at an
approved location (sideyard or backyard). Note: In neighborhoods where new “refuse carts” have been delivered, their use is
required. Compliance with the collection and storage requirements for refuse carts is the same as any other solid waste
container. Additional garbage or oversized garbage can be picked up for an additional charge. Contact 356-5180 for specifics
on those charges. A City supplied blue recycling container or other approved container shall be used for recycling. Recycling
information is available online at www.icgov.org/garbage or by telephoning 356-5180.
8. Parking. We acknowledge that we cannot park on the grass or across the public sidewalk and that the Landlord provides ___
off-street paved parking spaces or other parking areas as approved by the City.
9. Noise/Disorderly House. It is a simple misdemeanor (a crime, with a fine of $65 to $625 plus surcharge and court costs) to
keep a "disorderly house." Under Iowa City City Code section 8-5-5, a "disorderly house" is:
No person shall permit or suffer to continue, without taking legal steps to prevent the same, any quarreling, fight,
disorderly conduct, or other conduct or condition that threatens injury to person or damage, or loud, raucous,
disagreeable noises to the disturbance of the neighborhood, or to the disturbance of the general public, upon a premises
owned by the person or in the person's possession. For purposes of this Section, "to the disturbance of the general public"
includes the disturbance of persons beyond the subject premises and/or to the disturbance of person upon public places,
including peace officers.
Keeping a “disorderly house” is also a municipal infraction (civil offense) under section 8-5-5C punishable by a civil penalty
of $750 for the first offense and $1,000 for the second and subsequent offenses, plus court cost. Failure to answer the door
when the police arrive may result in a municipal infraction being issued to all tenants.
10. Snow and Grass. City Code section 16-1A-8A provides that snow must be removed within 24 hours of a 1-inch snowfall and
section 6-3-2 provides that lawns/grass/weeds cannot exceed 10 inches in height. Pursuant to the lease, we acknowledge that
the Tenant/Landlord (cross out one) is responsible for snow removal and the Tenant/Landlord (cross out one) is responsible
for mowing the grass. Regardless of the agreement between the landlord and the tenant, the City Code provides that the City
may hold the owner, operator, or tenant ultimately responsible, and violation of either section noted above can result in a fine
of $250.00 for the first violation and/or the City mowing the grass/shoveling the snow and assessing the cost of doing so to
the property owner.
11. Neighborhood Services Coordinator. Iowa City has a neighborhood services coordinator. For more information, call 356-
5237 or go to the City website (www.icgov.org/neighborhoodservices).
12. State Law. The Iowa Uniform Residential Landlord and Tenant Act (Iowa Code Chapter 562A) can be found at the Iowa
City Public Library and can be accessed on the internet at www.legis.iowa.gov.
13. Rental Deposits. The Iowa law on rental deposits can be found at Section562A.12 of the Iowa Code. The landlord has the
right to withhold from the rental deposit (also called the security deposit) such amounts as are reasonably necessary to restore
the premises to the condition at the commencement of the tenancy, ordinary wear and tear excepted. The tenants need to
provide the landlord with the tenant’s mailing address or delivery instructions for return of the rental deposit. Additional
information related to leases, move-in, move-out, and checklist may be found on the website at
http://web.offcampuspartners.com/116/resource/iowa/?p=tenant
We, the undersigned, have read the Informational Disclosure and Acknowledgment form and completed the blanks to the best of our
knowledge.
Landlord:________________________________ Date:
Tenant: Date:
Tenant: Date:
Tenant: Date:
Tenant:______ Date:
Tenant: Date:
**Note** All tenants, except minor children of tenants, must sign
this form even if they have an oral rental agreement.
Hisins\informational disclosure2012.doc