REQUEST FOR ANNUAL NOTICE OF ADDRESS,
REPRESENTATIVE AND RENTAL STATUS

Civil Code Section 4041 requires each homeowner to provide the Association with the following information on an annual basis. Please complete this form (questions 1-6 must be answered) and return to the address below:

1. Names of Homeowner(s):

2. Property Address within the Association:

3. The address or addresses to which notices from the Association are to be delivered:

4. An alternate or secondary address to which notices from the Association are to be delivered:

5. The name and address of your legal representative, if any, including any person with power of attorney, or other person who can be contacted in the event of your extended absence from the separate interest:

6. Is the separate interest that you own (check one):
Owner-occupiedRented outVacantUndeveloped Land


Additional Contact Information to be used should an issue arise within the Association (optional):

Phone Number:

Cell Phone:

Email Address:


Note: if an owner fails to provide the information above, the property address and the secondary address will be deemed the addresses to which notices are to be delivered which will result in additional costs to the Association for additional mailings.