Rental Notification

Tenant Name(s), Phone(s) & Email(s)*

Tenants permitted access the Gallery Website including Governing Documents, Activities, Forms, Calendar, etc. (strongly recommended):*

YesNo
Number of Vehicles*

Vehicle Data*

Property Owner Name & Address*

	First & Last Name	Address
1. Owner
2. Owner

Property Owner Contact Info*

	Home Phone	Work Phone	Email
1. Owner
2. Owner

PURSUANT TO FEDERAL HOUSING FOR OLDER PERSONS ACT, AN AGE VERIFICATION IN THE FORM OF A GOVERNMENT ISSUED ID MUST BE COMPLETED BY EVERY OWNER OR RESIDENT.

I HEREBY ASSERT THAT AT LEAST ONE OCCUPANT OF THE RESIDENCE/CONDOMINIUM SHALL BE FIFTY-FIVE YEARS OF AGE OR OLDER.

I declare under penalty of perjury under the laws of the State of California that the foregoing statements are true and correct.
This document is being executed on date and city entered below:
Date*

MonthDayYear
Date
City*
City in California
Name of Qualifying Resident 55 years of age or older
Please include a signed, dated copy of the current lease:

File type pdf preferred. If a digitized copy is not available, please provide a paper copy to the Gallery Office.
Cancelof
Signature of Property Owner*

Clear
Use your mouse of finger to sign.
22 Calle Galeria San Clemente, CA 92673 (949) 361-4685

Talega.gallery@seabreezemgmt.com

Form: 11/23/21
Should be Empty:

RENTAL NOTIFICATION FORM