APPLICATION TO PURCHASE AND APPLICATION FOR RESIDENCY CYPRESS BEND CONDOMINIUM IV ASSOCIATION, Inc. Building 10 2108 S Cypress Bend Drive Building 11 2106 S Cypress Bend Drive Building 12 2104 S Cypress Bend Drive Building 14 2216 N Cypress Bend Drive Pompano Beach, Florida 33069 C/O J & L Property Management, Inc. 10191 W. Sample Road, Suite 203, Coral Springs, Florida 33065 Phone: 954-753-7966 Ext. 105, Fax: 954-753-1210 Email: Marilyn@JLPropertymgmt.com Please complete this APPLICATION for CBIV fully and truthfully. PRINT ONLY (clearly and legibly) unless your Signature is indicated. Print NA (i.e. not applicable) on any line that does not apply. All personal information is viewed only by the CBIV Board of Directors and its Management Agent for purposes of this application. Upon completion submit all pages of this entire application with required attachments and documentation to CBIV c/o J&L Property Management, Inc. Upon submission and acceptance of this application the prospective tenant will be obliged to complete an in person interview with the Application Review Committee of the Cypress Bend Condominium IV Association Board of Directors. INDEX Title Page and Instructions page 1 Application for Purchase and Residency pages 2-9 Checklist page 10 1
APPLICATION TO PURCHASE AND FOR RESIDENCY All of the following pages 2-9 are to be completed by the Purchaser APPLICANT NAME: DOB://_ SSN: / / Please attach a legally valid form of photo I.D. either Driver s License or other identification. DRIVER S LICENSE I.D. NO.STATE EXPIRATION DATE/_/ OTHER PHOTO I.D. PHONE: ( ) - - EMAIL: _@ CO-APPLICANT/SPOUSE NAME: DOB://_ SSN: / / Please attach a legally valid form of photo I.D. either Driver s License or other identification. DRIVER S LICENSE I.D. NO. STATE EXPIRATION DATE/_/ OTHER PHOTO I.D. PHONE: ( ) - - EMAIL: @ Note! If the applicant and co-applicant are a couple who are married or legally registered domestic partners a copy of their certificate of same must be attached and submitted with this application. NUMBER OF PEOPLE WHO WILL OCCUPY: Adults over 18 Children over 13 Children under 13 List the NAMES OF THOSE OTHER THAN Applicant and Spouse/Co-Applicant who will occupy the unit. NAMEAge: NAMEAge: WILL A PET (1 small dog OR up to 2 cats) also reside in this Unit? _YES _NO If yes please complete the separate PET REGISTRATION FORM on page 9 of this application. At any time during this application process or subsequent residency: IN CASE OF EMERGENCY NOTIFY: ADDRESS: PHONE _/ / 2
Former and Current Residency PRESENT ADDRESS: FROM: _ TO: NAME OF COMPLEX _ STREET APT NO. CITY STATEZIP LANDLORD/or/MORTGAGE CO: PHONE: () CITYSTATEZIP PREVIOUS ADDRESS: FROM: _ TO: NAME OF COMPLEX _ STREET APT NO. CITY STATEZIP LANDLORD/or/MORTGAGE CO: PHONE: () CITYSTATEZIP Employment APPLICANT S PRESENT EMPLOYER:_ STREET:_APT NO. CITY:_STATE ZIP LENGTH OF EMPLOYMENT: _POSITION:ANNUAL SALARY: APPLICANT S PREVIOUS EMPLOYER: STREET:_APT NO. CITY:_STATE ZIP LENGTH OF EMPLOYMENT: _POSITION:ANNUAL SALARY: SPOUSE OR CO-APPLICANT S PRESENT EMPLOYER: STREET:_APT NO. CITY:_STATE ZIP LENGTH OF EMPLOYMENT: _POSITION:ANNUAL SALARY: SPOUSE OR CO-APPLICANT S PREVIOUS EMPLOYER: STREET:_APT NO. CITY:_STATE ZIP LENGTH OF EMPLOYMENT: _POSITION:ANNUAL SALARY: 3
Bank Information BANK NAME: CONTACT: PHONE:( ) STREET: CITYSTATE_ZIP_ CHECKING # OPENING DATE /_/ SAVINGS # _OPENING DATE _/_/ BANK NAME: CONTACT: PHONE:( ) STREET: CITYSTATE_ZIP_ CHECKING # OPENING DATE /_/ SAVINGS # _OPENING DATE _/_/ Character References Note! References should be individuals who can objectively attest to your personal, professional and general character. For example: neighbor, teacher, clergy or employer. They may not be a spouse, child, relative, significant other, your agent, attorney or similar professional engaged by you. Comments by referrers are held confidentially. (Two references minimum per applicant) 1) NAME_HOME PHONE ( )_WORK ( )_ STREET CITYSTATEZIP Relationship to Applicant: _ Information regarding: 2) NAME_HOME PHONE ( )_WORK ( )_ STREET CITYSTATEZIP Relationship to Applicant: _ Information regarding: 3) NAME_HOME PHONE ( )_WORK ( )_ STREET CITYSTATEZIP Relationship to Applicant: _ Information regarding: 4) NAME_HOME PHONE ( )_WORK ( )_ STREET CITYSTATEZIP Relationship to Applicant: _ Information regarding: 4
VEHICLE REGISTRATION/ PARKING APPLICATION Note! If you are also applying for a second vehicle to be parked at CBIV please photocopy this page first and submit a completed Vehicle Registration for each vehicle. Date: / / Building Number: _ Apartment (Unit) Number: Applicant s Name: Current Address: Telephone: - - I/We hereby apply to have the approval of Cypress Bend IV Condominium Association to park the following vehicle in the assigned parking space of the above indicated building and apartment. Make and Model of Vehicle: Model Year: Tag Number (License Plate) VIN State/Province: _ Attach a clear and recognizable copy of each of the following for this vehicle to this application: 1. Vehicle Registration 2. Individual Driver s License 3. Photos of the vehicle from both front and rear showing the license plate Please note that this application can only be processed if the above attachments are provided. Signature of Applicant: Date: (If applicable) Signature of Co-applicant: Date: OFFICIAL USE ONLY Approved by: Date: Vehicle Parking Permit Number Parking Space Number _ Note! This approval is valid only for the above vehicle. Should you trade it in, sell it and replace it you will have to apply anew for Vehicle Parking/ Registration. 5
ACKNOWLEDGEMENT Rules and Regulations Each Acknowledgement Statement must be individually initialed on the line preceding the statement and then signed in full and dated at the bottom. Rules and Regulations received and read. I/We,, have received, read and understand the Rules and Regulations of Cypress Bend Condominium IV Association, Inc. as revised and adopted on July 15, 2010. No leasing or tenancy of the unit for 3 years from date of purchase. I/We specifically acknowledge the Rule and Regulation that I/We may not lease or allow tenancy, in whole or in part, either paying or non-paying for 36 consecutive months (3 years) beginning with the date of purchase. No more than 4 approved individuals may occupy a unit. I/We specifically acknowledge the existence and pledge to follow the Rule and Regulations requirement that no more than 4 approved individuals are permitted to occupy a unit. Furthermore I/We pledge that guests residing in the unit will register by name and appropriate photo I.D. with Cypress Bend Condominium IV Association, Inc no later than 14 days after arrival and that prior to 30 days after arrival will submit an Application for Residency. Such application will require a background/criminal check. An application processing fee of $100 will accompany the application to the management company indicated at the bottom of this page. Promise and commitment to observe the rules and regulations. I/We furthermore state by my/our signature(s) hereafter inscribed that we will observe these rules and such future rules and regulations as shall be lawfully adopted and published by the Board of Directors of Cypress Bend Condominium IV Association, Inc. Signature: Date: Signature: Date: OFFICIAL USE ONLY Accepted for the CBIV Board of Directors Screening Committee on _/_/ by: 6
AFFIDAVIT OF LEGAL RESIDENCY IN THE UNITED STATES OF AMERICA Note! Each applicant for residency 18 years of age and up must separately complete the following and attach necessary documentation. If more than two (2) permitted applicants are being applied for please copy this page first and submit it additionally with the required documents.. APPLICANT 1 1. Are you a citizen of the United States of America? YES NO_ If NO then 2. Are you legally permitted to reside in the United State of America? YES _ NO If YES then please provide and attach a copy of your current Immigration Visa, Green Card or other proof of United States Residency Status. 3. Please enter your Social Security Number for verification by the CBIV Association:: /_/ Signature: Date: / / APPLICANT 2 1. Are you a citizen of the United States of America? YES NO If NO then 2. Are you legally permitted to reside in the United State of America? YES _ NO If YES then please provide and attach a copy of your current Immigration Visa, Green Card or other proof of United States Residency Status. 3. Please enter your Social Security Number for verification by the CBIV Association. / /_ Signature: Date: // 7
APPLICATION FOR PET REGISTRATION Date: / / Building Number: _ Apartment (Unit) Number: Applicant s Name: Current Address: Telephone: - - I/We acknowledge the Ordinances of Broward County, Florida and of the City of Pompano Beach, Florida regarding pets and the Rules and Regulations of CBIV and as they pertain to the keeping of pets (one (1) dog of 25 lbs or less, or two (2)cats) and by our signature(s) inscribed below agree to abide by the same rules, regulations and ordinances. I/We hereby apply to have the approval of Cypress Bend IV Condominium Association to house the following pet(s) in the above indicated building and apartment. (1) Type of Pet: Name of Pet: _ Weight: lbs. Color(s): Age: Attach a photograph of this pet and a veterinary certificate of health and immunization. (2) Type of Pet: Name of Pet: _ Weight: lbs. Color(s): Age: Attach a photograph of this pet and a veterinary certificate of health and immunization. OFFICIAL USE ONLY This application is accepted for the Board of Directors of CBIV Association by: _ Date: / / Note! This approval is valid for the above mentioned pet(s) only. 8
INDEMNITY LETTER / / (Unit Owner s Name) (Building Number) (Unit Number) Date: _/ / To Whom It May Concern: I, the undersigned, agree to indemnify and hold harmless Cypress Bend Condominium IV Association, Inc from any and all liability, defense costs, including attorney fees and all other fees incidental to defense, loss or damage Cypress Bend Condominium IV Association, Inc may suffer as a result of claims, demands, costs or judgments against it due to damage to the Common Elements or other Units as a result of leaking water, willful mischief and negligence or neglect by the owner or his lessees and/or occupants. _ (Signature of Owner) _ Street Address _ (Printed Name of Owner) _ City, State, Zip _ (Signature of Lessee and/or Occupant) PUBLIC NOTARIZATION STATE/PROVINCE OF COUNTY OF Before me personally appeared to me well known and to me to be the person described in and who executed the foregoing instrument, and acknowledged to and before me that executed said instrument for the purposes therein expressed. NOTARY PUBLIC STATE/PROVINCE MY COMMISSION EXPIRES // NOTARY STAMP 9
CHECKLIST Please be sure that you have completed the entire application; provided full and accurate information as well as attached or submitted all requested and necessary documentation. Incomplete applications cannot be processed. I entered complete information on all applicable lines of this application form. Where a line or section does not apply (for instance no second or co-applicant) I have indicated NA to show that the line or section is deliberately left blank. Where applicable I have included with this application the following additional documentation: A copy of the signed Purchase Contract/Lease Agreement A non-refundable application fee of $100 payable to Cypress Bend Condominium IV Association, Inc. A photograph/picture of my pet(s) A photograph/picture of any vehicle for which I am requesting permission for parking. A copy of drivers license. A copy of vehicle registration. Proof of Marital Status Proof of Legal U.S. Residency Status (Visa, Passport, Green Card, Alien Resident Card etc.) A $500 Security Deposit for tenancy. Signed before a Notary Public all acknowledgements pages of the application form. APPLICANT INTERVIEW Upon receipt of a fully complete application an in person interview with the Application Review Committee of the Cypress Bend Condominium Association IV, Inc. will be scheduled. The interviewers will provide further information and instructions and finalize acceptance of the application. Please note that Cypress Bend Association IV, Inc. and its management agents have 30 days from the receipt of your completed application to process and complete your request. Your attention to providing all the requested information will assure an on time processing of your application. Cypress Bend Condominium IV Association, Inc. C/O J & L Property Management, Inc. 10191 W. Sample Road, Suite 203, Coral Springs, Florida 33065 Phone: 954-753-7966 Ext. 105, Fax: 954-753-1210 Email: Marilyn@JLPropertymgmt.com 10