lmoabarcodeform

LMOA BARCODE APPLICATION ONLINE FORM (2024)

last updated January 3, 2024
**Please note**

Barcode prices have been adjusted in 2024

Resident Barcode - $15

Guest Barcode - $40

Social Associate Barcode - $15

Golfer Barcode - $15

Utility Vehicle - $15

Commercial Vehicle - $100
Applicant Information

Part 1
I am a*

Property OwnerNon-owner Resident *TenantPermanent Guest **Business or VendorEssential Services ***Utility CompanyGolf Associate****Social Associate
Calculation
*Non-owner Resident: is a permanent resident who pays no rent but resides in a member's home. Proof of residency is required (official mail or postal change of address)

**Permanent Guest: a guest who is currently registered on a member's permanent guest list (no more than four per list)

***Essential Services: Includes LMOA employee and contract employee, law enforcement, Fluvanna County agencies, US Postal Service Carriers, Lake Monticello Volunteer Fire and Rescue Squad, Fluvanna County and local private school vehicles, clergy.

****Golf Associate: Golf Associate Members may receive, upon written application and payment of the applicable fee, one (1) gate access device valid for entry through a limited number of Lake Monticello gates. The gate access device shall be valid during restricted hours appropriate to use of the golf course. Use of the device shall be in compliance with LMOA policy PM 19.03.
Letter from Owner*

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Letter from owner that applicant resides on property Cancelof
Proof Change of Address*

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Official Mail w/property address Cancelof
Letter from Supervisor*

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Cancelof
If you are a new Property Owner or Tenant, please make sure you fill out the New Member/Property Owner Registration Form FIRST otherwise your barcode application will be rejected. The form can be filled out HERE: LMOA NEW RESIDENCY REGISTRATION
Property Lease*

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First page only Cancelof
Vehicle Lease*

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First page only Cancelof
Lease Start Date*
Lease End Date*
Applicant Name (as it appears on Photo ID)*

First NameLast Name
Applicant Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of LMOA Sponsor (as it appears on Photo ID)*

First NameLast Name
Sponsor LMOA Address*

Street Address

Street Address Line 2

CityState

Post code
Company Name*
Cell Phone Number of Applicant*

Area CodePhone Number
E-mail Address of Applicant*
Applicant's email address
Business Barcode Access Request

Business barcodes are issued at the sole discretion of LMOA. Business barcodes are issued solely for the purposes of conducting official business for residents. Business barcodes do not allow usage of any LMOA amenities. Those violating any policies of LMOA will have their barcode deactivated and no refund will be issued. Business barcodes will only be issued to businesses that can verify they are operating in accordance with Virginia law.
Name of Business*
Type of Business*
Name of Owner or Responsible Party*
Address of Owner or Responsible Party*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Structure (sole proprietor, partnership, corporation)*
Explain why you want an LMOA Business Barcode*
Fill in here
How many clients in Lake Monticello do you currently service?*
Do you perform work at an hourly rate or do you charge a per job fee?*
Do you perform work billed per job in excess of $1,000 in aggregate per address? *
Please provide a valid copy of your VA Contractor's license*

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Cancelof
Please provide proof of business insurance*

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Cancelof
Please list your Virginia Tax ID Number or Employer Identification Number*
Key Rules

LMOA Business Barcode
Solicitation for business or placing advertising materials in resident's mailboxes is prohibited. The posted speed limit is 25 mph. Those found to be speeding will have their barcodes revoked.

All efforts shall be made to not impede traffic or park in the road. If parking in the road, safety cones are required.

Contract construction hours at Lake Monticello are between 7:00 AM and 7:00 PM. Construction activity during other hours is prohibited. All contract construction work on Sunday, Christmas Day, New Year’s Day, Labor Day, Thanksgiving Day, and the Fourth of July is prohibited. Exceptions may be made for emergency work.

No burning of debris, trash, trees, or limbs.

Any activity that constitutes disturbing the peace is prohibited.

In consideration of being issued an access control device and granted access to LMOA roadways, I agree for myself, my personal representative, heirs, successors, and assigns to indemnify and hold harmless Lake Monticello Owners' Association, its directors, officers, employees, from any and all liabilities or claims made because of injury use of such device and roadways.

The undersigned named below does hereby represent that he/she is, in fact, acting in such capacity and is fully responsible to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim or damages whatsoever, which may be imposed upon said parties because of any claim for bodily injury or vehicle damage.

I hereby certify that I have read this document, and I understand its content. I am aware that this is an indemnification agreement and I sign it of my own free will.
Signature*

Clear
Date*

MonthDayYear
Date
Barcode Type

Part 2
I need the following*

New BarcodeDamaged Barcode ReplacementDeactivate Barcode
Will you be removing a vehicle from your household account as a result of this new barcode application?*

YESNO
If Yes, what is the Year, Make, and Model?
New Vehicle Information

Part 3
License Plate*
State Issued*
Year*
Make of Vehicle*
Model*
Color*
VIN*
Please enter 17 Digit VIN
upload the state REGISTRATION for your automobile (as shown above) *

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Cancelof
The person receiving an LMOA access barcode shall indemnify, protect, and hold harmless the LMOA and its Board of Directors from and against all liabilities, obligations, claims, accidents, casualties, occurrences, damages, causes of action, costs and expenses, including without limitation, reasonable attorney's fees, and expenses, imposed upon or incurred by or asserted against the Association or its Board of Directors by reason of the issuance of this access device. The Association and its Board of Directors reserve the right to designate counsel. The use of this access device is governed by the current conditions set forth by LMOA, which may be amended without notice from time-to-time. The holder of the LMOA access barcode agrees to surrender the access device to the LMOA upon demand.

Barcodes cannot be transferred from the orginally issued vehicle.
Should be Empty:

LMOA BARCODE APPLICATION ONLINE FORM (2024)

Applicant Information

Business Barcode Access Request

Key Rules

Barcode Type

New Vehicle Information