lmoabarcodeform

LMOA BARCODE APPLICATION ONLINE FORM (2023)

last updated January 10, 2023
Applicant Information

Part 1
I am a*

Property OwnerNon-owner Resident *TenantPermanent Guest **Business or VendorEssential Services ***Utility CompanyGolf AssociateSocial 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.
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
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
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 Number*
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.
Should be Empty:

LMOA BARCODE APPLICATION ONLINE FORM (2023)

Applicant Information

Barcode Type

New Vehicle Information