The undersigned Tenants of the property are members of the household that will reside at______________________________________________________________________ (address) within the Dwelling Unit.

The homeowner hereby certifies that the Tenant has personal knowledge of the ages of the anticipated Residents of the Dwelling Unit that will reside at the Property and at least one Resident is an Age-Qualified Occupant (as defined in Section 1.2 of the Declaration of Covenants, Conditions & Restrictions).

The homeowner also certifies that all anticipated Residents of the Dwelling unit are over the age of 19 and that they will comply with the rules and regulations of the Falls Run Community Association.

The Tenant must attach a copy of one of the following documents, which includes a date of birth for the Resident that is 55 years of age or older (check applicable document):

The Tenant hereby further declares that the facts stated in the foregoing certification are true and correct to the best of the Tenant’s knowledge, information and belief.

Resident occupant(s):

_________________________________________ __________________

Signature Date of Birth

_________________________________________

Printed Name

_________________________________________ __________________

Signature Date of Birth

_________________________________________

Printed Name

Other persons residing at this address (optional):

_________________________________Age__________