Mansions West Resale Application Check List Date of Application: Closing Date: Property Agent Phone Number: Check List Needed for Resale Master Association Check - $200.00 Made payable to "Evergrene Master Association, Inc." Resident Registration Form Resale Application Affidavit of Receipt of HOA Documents (Notarized) Pet Registration Form Veterinarian Certification Consent, Waiver, Release and Indemnification Agreement Copy of Sale Contract Collect @ Closing Capital Contribution for both Master & COA (1 Quarter of Annual Assessment collected at closing) ***After closing bring a copy of Warranty Deed and Settlement (HUD) Statement to Clubhouse to receive barcode access and club ID s. Notes: Page 1 of 9
Evergrene Property Applicant 1 First and Last Applicant 2 First and Last Telephone Number: Cell Phone Number: E-Mail Resident Registration Form EVERGRENE MASTER ASSOCIATION, INC. By submitting your e-mail address to be the primary source of communication. You are authorizing all correspondences and meeting notices associated with Evergrene to be sent to this e-mail address. This information will not be used for any other purpose Other Residents: Please list anyone living with you. This would include all family members. First Name Last Name Date of Birth Phone Number Relation Vehicle Information Make / Model Year Color Tag Number State Please list family members and guests you wish to allow permanent access to your property without prior notice. Your guests must present proper identification. If your guest is not on the permanent list, the Gate will call you for permission to allow this guest entry. PERMANENT GUESTS PERMANENT GUESTS Page 2 of 9
RESALE APPLICATION 650 Evergrene Parkway, Palm Beach Gardens, FL 33410 PHONE: 561-626-1981 FAX: 561-626-7186 Date: APPLICANT(S) INFORMATION: If unrelated, please provide for each applicant. Applicant #1: Telephone # s: Email: Social Security #: Date of Birth: Applicant #2: Telephone # s: Email: Social Security #: Date of Birth: Please name all Occupants Relationship to Lessee 1. 2. 3. 4. LICENSED DRIVERS: To be residing in the community License #: State: License #: State: License #: State: License #: State: Page 3 of 9
PERSONAL REFERENCES: (Do not list relatives) Phone: Phone: RESIDENCE HISTORY: If less than 5 years, provide previous residence information on separate sheet City: State: Zip: City: State: Zip: City: State: Zip: WORK HISTORY: Applicants 1 and 2. If less than 5 years, provide previous employer information. Employer: Applicant 1 Applicant 2 Phone: Position: Employment Dates: EMERGENCY CONTACT INFORMATION: SECURITY BACKGROUND I UNDERSTAND A NATIONWIDE LAW ENFORCEMENT INVESTIGATION IS REQUIRED AND WILL BE DONE. Have you (or other applicant) ever been convicted of a state or federal offense? Yes No Have you (or other applicant) ever been convicted of a felony in the past 7 years? Yes No Are you (or other applicant) presently awaiting trial on any criminal offense? Yes No IF YES TO ANY OF THE ABOVE, GIVE APPLICANT S NAME, DATES, NAME OF COURT AND DETAILS OF CONVICTION ON A SEPARATE SHEET AND ATTACH. ============================================================================================= Page 4 of 9
ACKNOWLEDGEMENT BY APPLICANT(S) By signing below, I/We hereby certify: 1. That I/We agree on behalf of all persons who may use the unit, which I seek to lease and myself, that I/We will abide by all the Restrictions in the By-Laws, Rules and Regulations, and Association Documents. 2. That I/We agree that all of the information contained in the application is true and complete and that any False or Misleading information given in this application constitutes grounds for rejection of this application and revocation of my right to reside on this property. 3. That I/We give my/our permission for a Nationwide Law Enforcement Background investigation and credit history verification. 4. That no persons other than those shown on this application will reside in the unit and I/We agree that anyone moving into the unit at a later date will be registered with the Association and a background investigation done at the applicant s expense. 5. I/we acknowledge that I/we have received, read, understand and agree to abide by the Documents and the Rules & Regulations. Signature of Applicant 1: Signature of Applicant 2: Signature of Witness: Date: Date: Date: Page 5 of 9
EVERGRENE MASTER ASSOCIATION, INC. Affidavit of Receipt of Association Documents (All documents are available on our community website, www.evergrene.com) This is to certify that I, intend to purchase and that accordingly, I have received the Master Declaration of Covenants, Conditions and Restrictions and the Rules and Regulations for Evergrene Master Association, Inc. This is certified to be so by: Owners Signature STATE OF FLORIDA COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me the day of, 20 by who is personally known to me or who produced as identification and who did (not) take an oath. My Commission Expires: Notary Public State of Florida at Large Page 6 of 9
PET REGISTRATION FORM I do not own a pet Signature: Owner Information Phone: Pet Information Type of Pet Breed Color Weight Name 1. Rabies Certification Number: Is the pet micro chipped? Yes No Micro Chip # Required Certification from Veterinarian verifying pet weight and vaccines Type of Pet Breed Color Weight Name 2. Rabies Certification Number: Is the pet micro chipped? Yes No Micro Chip # Required Certification from Veterinarian verifying pet weight and vaccines Type of Pet Breed Color Weight Name 3. Rabies Certification Number: Is the pet micro chipped? Yes No Micro Chip # Required Certification from Veterinarian verifying pet weight and vaccines Page 7 of 9
CONSENT, WAIVER, RELEASE, AND INDEMNIFICATION AGREEMENT FOR USE OF THE CLUB AT EVERGRENE FACILITIES (hereinafter referred to as the Undersigned ) Over Age 18: Yes No The Undersigned, as a condition to entering and/or using the Club Facilities of the Club at Evergrene (the Club ), understands and agrees to the terms herein and makes the following Representations and Warranties: (i) the Club Facilities include the Club building, parking areas around the Club, Fitness Center and lockers, pools and pool decks ( Club Facilities ); (ii) the Club is not responsible for any loss or damage to any private property of any kind whatsoever, used or stored in the Club Facilities, including but not limited to all risk of loss respecting motor vehicles, bicycles, equipment, jewelry or other possessions; (iii) the use of any apparatus, appliance, swimming pool, facility, privilege or service whatsoever owned, leased or operated by the Club, or participation in any contest, game, function, exercise, competition or other activity operated, organized, arranged or sponsored by the Club, either on or off the Club Facilities, is at the sole risk of the Undersigned and the Club is not responsible for and is released from any and all action, injuries, claims, losses, liabilities, damages, costs and expenses of any kind or nature whatsoever respecting any personal injury or death occurring at the Club or respecting Club Facilities; (iv) there may be no adult supervision and there are no lifeguards on duty at the swimming pool; (v) the Undersigned has consulted with a physician regarding any health implications to the Undersigned as a result of use of the Fitness Center and the Undersigned has been advised by said physician that s/he is physically well enough to use the Fitness Center; (vi) the Undersigned shall be solely responsible for the supervision of any minors admitted into the Club Facilities accompanying the Undersigned, and shall be responsible to the Club for any damage caused by such minors; and (vii) failure to pay Association Dues and/or to abide by the Evergrene Master Association Rules and Regulations may result in suspension of the Undersigned s right to use the Club Facilities. Page 8 of 9
The Undersigned does hereby unconditionally, fully, and completely release the Club at Evergrene, Evergrene Master Association, Inc., and all sub-associations (the Released Parties ), and all of the current, previous, and future officers, directors, attorneys, agents, employees, and servants of any of the Released Parties, and also including any and all persons or entities who might have or claim to have rights of recourse or claims for indemnity or contribution against any of the Released Parties, from all and every manner of causes of action, claims, suits, controversies, liabilities, trespasses, damages, judgments, executions, and demands whatsoever, whether in law or in equity, whether civil, legal, ethical, moral, or otherwise, which the Undersigned has, can, shall, or may have in the future, both known and unknown, against any person or entity comprising the Released Parties for, upon, or by reason of any matter, cause, or thing whatsoever respecting or resulting from the use of the Club Facilities by the Undersigned including but not limited to the negligent acts or omissions of any of the Released Parties or any other person using the Facilities, and specifically including but not being limited to claims or liabilities arising from the death of or personal injury to the undersigned, all of which are waived. The Undersigned shall hold the Released Parties harmless and indemnify the Released Parties from all loss, liability, claims, and expense, including reasonable attorneys and paraprofessional fees, costs, expenses not otherwise taxable as costs, and accountants and other experts fees, whether or not taxable under applicable court rules, incurred in the defense of any such claim (whether in a court of original jurisdiction or one or more courts of appellate or other jurisdiction), made by or asserted by the Undersigned, or any person who may acquire subrogation rights respecting any claim by the Undersigned, including but not limited to any insurer, and/or arising out of the failure of the Representations and Warranties to be true at any time that the Undersigned uses the Club Facilities. The Undersigned acknowledges that the Club at Evergrene would not have accepted this Consent or permitted the Undersigned to use the Club Facilities without the Undersigned agreeing to the Representations and Warranties and the warranties and indemnities provided in this Consent. Dated this day of, 20. Signature: Printed Signature: Printed Page 9 of 9