| TAMIAMI VILLAGE MANAGEMENT APPLICATION FOR OWNERSHIP/RESIDENCY | |||||||||
| Applicants Last Name: | First Name: | Middle Int: | Suffix (Jr/Sr): | ||||||
| Village Address: | SS#: | Birth Date: | |||||||
| Co-Applicant's Last Name: | First Name: | Middle Int: | Suffix (Jr/Sr): | ||||||
| Co-Applicant's Northern Address: | SS#: | Birth Date: | |||||||
| Applicant's Northern Address: | First Name: | Middle Int: | Suffix (Jr/Sr): | ||||||
| Northern Phone: | Southern Phone: | Cell Phone: | Closing Date: | Move In Date: | |||||
| Prior Address: | City: | State: | Zip Code: | How Long?: | |||||
| Additional Occupant: | SS#: | Birth Date: | Pet(s) Name: | ||||||
| Renter's Arrival Date: | Renter's Departure Date: | Type of Pet: | |||||||
| Caregiver: | Yes_____ | No______ | If yes, caregiver portion must be completed by attending physician. | ||||||
| Caregiver: | |||||||||
| Does patient have a handicap as defined by law? | Yes ______ | No ______ | |||||||
| Is a caregiver necessary to accommodate the handicap | Yes ______ | No ______ | |||||||
| Estimated Length of stay: _____________________________ | |||||||||
| Relationship between patient's handicap and the need for the requested accomodation: ___________________________ | |||||||||
| Print Physician's Name: | Physician's Signature: | ||||||||
| Emergency Contact (North): | Relationship: | Phone #: | |||||||
| Street Address: | City: | State: | Zip Code: | ||||||
| Emergency Contact (South): | Relationship: | Phone #: | |||||||
| Street Address: | City: | State: | Zip Code: | ||||||
| HAVE YOU OR ANYONE IN YOUR HOUSEHOLD BEEN CONVICTED OF A FELONY OR SEX CRIME? Yes____ No____ | |||||||||
| This is an application for residency. Completing the application does not in itself grant residency into the community. | |||||||||
| I hereby certify that the facts set forth in the above application are true and complete to the best of my knowledge. | |||||||||
| I understand that if accepted, "falsified statements on this application" shall be considered cause for eviction. | |||||||||
| You are hereby authorized to make any investigation of my personal history and financial and credit record through any | |||||||||
| investigation or credit agencies or bureaus of your choice, based on the above information. | |||||||||
| There is a $100.00 administration fee payable to Tamiami Master Association, Inc. to be submitted with this completed | |||||||||
| rental or residency application. | |||||||||
| By signing below "I hereby agree to abide by and follow the rules and regulations of the Community as set forth in its' | |||||||||
| governing documents." | |||||||||
| Signature of Applicant | Signature of Co-Applicant | ||||||||
| Date Application Signed | Date Application Signed | ||||||||
| Date Approved | Approved By | ||||||||