HOPA Age Qualification Form

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Kissing Tree (the “Community”) is an age-qualified neighborhood for persons 55 years of age or older. Individuals who are under 55 may not occupy the Residence for more than 30 consecutive days or more than a total of 45 days in a 12 month period, unless they satisfy specific criteria under applicable federal law for permanent occupancy. Applicable age and other occupancy criteria for each resident are set forth in the Kissing Tree Housing for Older Persons Act Policy (the “Policy”) and various Kissing Tree Development Area Declarations (the “Declarations”). Kissing Tree Master Community (the “Association”) is required under the Declarations to monitor and enforce compliance with the age and occupancy criteria throughout the Community.

In order to ensure that the neighborhood continues to comply with applicable law, the information in this form will be collected by the Association at the first closing for the residence, the closing of each re-sale, the commencement of each lease term affecting the residence, and whenever a new occupant moves into the residence, but in no event less frequently than once every two (2) years. The board of the Association (or the board of any sub-association) may, in its discretion, require that this information be collected more frequently if necessary to assess compliance with the Declarations and applicable law. The information collected in this form will be held in confidence to the degree possible. A written summary of the information you provide will be kept on file with the Association and/or an applicable sub-association and made available for inspection.

This form is to be completed by the owner or tenant of the property. Your cooperation is required under the Declarations and it is essential to preserving our continued right to operate as an age-qualified neighborhood.

You must upload a proof of age for one permanent occupant listed on this survey who occupies the Residence as an “age-qualified occupant.” You may mark out the license number or passport number. The Association reserves the right to verify any information given below. For purposes of this survey, a “permanent occupant” is one who occupies the Residence at least six (6) months in every calendar year.

This form is to assist owners, tenants and the Association in determining whether the occupants of the residence comply with the age and occupancy requirements of the Declarations. Persons who do not qualify for permanent occupancy under one of the categories described below and in the Declarations may not occupy the Residence for more than 30 consecutive days or more than a total of 45 days in a 12 month period.

The information below must be completed for each occupant of the Residence (both owner and non-owner) by an owner or tenant of the Residence. Nonresident owners are responsible for ensuring that all occupants of the Residence timely and fully comply with each survey and all applicable age and occupancy restrictions.

I, the undersigned, declare as follows:*

Please select one.

I am an owner of the Residence.

I am a tenant of the Residence.

How many people currently occupy the Residence?*

Name of Occupant 1*

First Last

Age of Occupant 1*

Date of Birth of Occupant 1*

Date Occupancy Commenced for Occupant 1*

Which of the following best applies to Occupant 1?*

The occupant is 55 years of age or older and occupies the Residence as a permanent occupant.

The occupant is younger than 55 years old and occupies the Residence as a permanent occupant with a waiver from the Founder.

Proof of Age

Using the field below, please upload a photo or scanned copy of one of the following documents for Occupant 1:

drivers license
passport
military identification
birth certificate
immigration card
any other state, local, national or international documentation

Proof of Age for Occupant 1*

Only one age-qualified Occupant needs to upload proof of age for the Residence.

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, heic, Max. file size: 10 MB, Max. files: 1.

Proof of Age Certification*

I certify that the proof(s) of age I attached to this form is/are a true and correct copy of the original(s).

Name of Occupant 2*

First Last

Date Occupancy Commenced for Occupant 2*

Which of the following best applies to Occupant 2?*

The occupant is 55 years of age or older and occupies the Residence as a permanent occupant.

The occupant is younger than 55 years old and occupies the Residence as a permanent occupant with a waiver from the Founder.

The occupant is 19 years of age or older and occupies the Residence with an Age-Qualified Occupant.

The occupant is 19 years of age or older and occupied the Residence with an Age-Qualified Occupant, and has continued, without interruption, to occupy the Residence after termination of the Age-Qualified Occupant’s occupancy thereof.

Name of Occupant 3*

First Last

Date Occupancy Commenced for Occupant 3*

Which of the following best applies to Occupant 3?*

The occupant is 55 years of age or older and occupies the Residence as a permanent occupant.

The occupant is younger than 55 years old and occupies the Residence as a permanent occupant with a waiver from the Founder.

The occupant is 19 years of age or older and occupies the Residence with an Age-Qualified Occupant.

Name of Occupant 4*

First Last

Date Occupancy Commenced for Occupant 4*

Which of the following best applies to Occupant 4?*

The occupant is 55 years of age or older and occupies the Residence as a permanent occupant.

The occupant is younger than 55 years old and occupies the Residence as a permanent occupant with a waiver from the Founder.

The occupant is 19 years of age or older and occupies the Residence with an Age-Qualified Occupant.

Name of Occupant 5*

First Last

Date Occupancy Commenced for Occupant 5*

Which of the following best applies to Occupant 5?*

The occupant is 55 years of age or older and occupies the Residence as a permanent occupant.

The occupant is younger than 55 years old and occupies the Residence as a permanent occupant with a waiver from the Founder.

The occupant is 19 years of age or older and occupies the Residence with an Age-Qualified Occupant.

Name of Occupant 6*

First Last

Date Occupancy Commenced for Occupant 6*

Which of the following best applies to Occupant 6?*

The occupant is 55 years of age or older and occupies the Residence as a permanent occupant.

The occupant is younger than 55 years old and occupies the Residence as a permanent occupant with a waiver from the Founder.

The occupant is 19 years of age or older and occupies the Residence with an Age-Qualified Occupant.

Name of Person Filling Out this Form*

First Last

Email*

Phone*

Agreement Statement*

I declare under penalty of perjury that all the foregoing statements are true and correct.

Signature*