• AGE VERIFICATION FORM

  • Pursuant to state and federal law, every owner of, or person residing in this
    community must complete an age verification form every two years to certify his or her eligibility to reside in this senior community. All residents must supply a proof of age (copy of driver's license, birth certificate, passport, etc.) The association reserves the right to verify any information given below. If you have questions about how to complete the form or need additional copies, please contact our office at 209.544.3422 or support@hoapro.com.

    Please note that each resident in a home must fill out a separate form and provide proof of age

  • Directions:

    1. SECTIONS A, B, C OR D OF PART 1 MUST BE COMPLETED BY EVERY PERSON RESIDING IN EACH HOME WITHIN THE ASSOCIATION (whether owners or renters.)
    2. OWNERS WHO DO NOT RESIDE IN THE ASSOCIATION SHOULD SKIP TO PART 2.
    3. PART 3 MUST BE COMPLETED BY ALL PERSONS SUBMITTING THIS FORM

  • Part 1

    EVERY PERSON RESIDING IN EACH HOME SHOULD COMPLETE THIS SECTION

  • A.  

  • B.
    health care to          who resides in the home.

  • C.       is a person 55 years of age or older ("the senior"), who resides (or formerly resided) in this residence; the senior either moved into the residence with me, or before I moved into the property.

    If the senior no longer resides in this residence, I certify that the senior left the residence because of: 
    a.  
    b.   
    c.   
    d.          

    I also certify that I am: 
    a.    
    b.            who is a resident of the home. 

  • D. who is a child or grandchild of a senior citizen or other qualified resident;

  • [If the person on whose behalf this form is submitted is not capable of executing the form, please have the person responsible for the care of such underage person complete the form and execute it on his/her behalf.]

  • Part 2

    FOR OWNERS WHO DO NOT RESIDE IN THE ASSOCIATION 

  • All the residents of my home, located at:
        
             
    are listed by name and age as follows:

  • Submit Proof(s) of Age
    Cancelof

  • Part 3

    CERTIFICATION AND SIGNATURE

  • IF I AM A RESIDENT OF THIS SENIOR COMMUNITY. I HAVE ATTACHED A PROOF OF AGE (ie. valid drivers license/ID, birth certificate, passport, etc.) TO THIS FORM AND I CERTIFY THAT IT IS A TRUE AND CORRECT COPY OF THE ORIGINAL. WHETHER I AM A RESIDENT OR NOT, I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING STATEMENTS ARE TRUE AND CORRECT.

  • On This Date
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