POINCIANA PLACE CONDOMINIUM VI THE BARCLAY BUILDING C/O CMC MANAGEMENT, INC., 2950 JOG ROAD, GREENACRES, FL ~ FAX

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1 POINCIANA PLACE CONDOMINIUM VI THE BARCLAY BUILDING C/O CMC MANAGEMENT, INC., 2950 JOG ROAD, GREENACRES, FL ~ FAX *(Please check one) Application for PURCHASE or RENTAL of Unit# Desired date of closing or occupancy Buyer/Renter Name(s): (Circle one) Address: REALTOR NAME: COMPANY: Phone Phone Phone APPLICATION FEE: $ *NON-REFUNDABLE* Separate $ Application Fee required for unmarried co-applicants Make check payable to Poinciana Place Condo 6 PROCESSING FEE: $60.00 *NON REFUNDABLE* Make check payable to CMC Management INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED PLEASE KEEP ALL PAGES INTACT. PLEASE ALLOW A MINIMUM OF TWO WEEKS FOR PROCESSING Copy of your Driver s License(s) Copy of vehicle registration(s) Copy of purchase or rental contract Copies of the following must be attached: If Purchase, Name of Closing Company: Phone: Please Note: TITLE COMPANY OR CLOSING ATTORNEY MUST REQUEST AN ESTOPPEL BEFORE CLOSING TO DETERMINE MONIES OWED TO THE ASSOCIATION BY THE OWNER OF THE PROPERTY. IF THIS PROCESS IS NEGLECTED, THE NEW OWNER MAY END UP BEING LIABLE FOR DELINQUENCY. A Certificate of Approval, which is required to close and prior to moving in, will be provided to the purchaser or renter after the interview. Make the check for the application fee payable to Poinciana Place Condo 6 If purchasing, you must supply the Management Company with a copy of your Warranty Deed and mailing address after closing. Purchaser is also required to inform the management company of any changes in mailing address. Maintenance fees are due monthly MARTY GRANT, LCAM PROPERTY MANAGER

2 WTC BACKGROUNDS, INC. We re The Choice! ACTION REQUEST X RENTAL HISTORY (Criminal, Credit & Eviction) Criminal History Statewide (FL) Criminal History/Out of State Civil Record by State Driving Records/History (MUST HAVE DL # FDLE Workers Comp Record SSN Verification Credit Report Sexual Offender Search NAME FIRST MI ADDRESS DOB SEX RACE SSN D.L.# COMPANY: _BARCLAY AT POINCIANA VI CONDO DATE Applicant Release In connection with for employment and or residency, I understand that investigative background inquiries are to be made on me including consumer credit, criminal conviction, motor vehicles, and other reports. Further I understand that WTC Backgrounds, Inc. will be requesting information from various State and other agencies which maintain records about my history. These records include but not limited to driving, credit criminal, and civil history. I authorize any party or agency contacted by WTC Backgrounds Inc. to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. This authorization and consent shall be valid in original, fax, or copy form. Applicant Signature Date

3 WTC BACKGROUNDS, INC. We re The Choice! ACTION REQUEST X RENTAL HISTORY (Criminal, Credit & Eviction) Criminal History Statewide (FL) Criminal History/Out of State Civil Record by State Driving Records/History (MUST HAVE DL # FDLE Workers Comp Record SSN Verification Credit Report Sexual Offender Search NAME FIRST MI ADDRESS DOB SEX RACE SSN D.L.# COMPANY: _BARCLAY AT POINCIANA VI CONDO DATE Applicant Release In connection with for employment and or residency, I understand that investigative background inquiries are to be made on me including consumer credit, criminal conviction, motor vehicles, and other reports. Further I understand that WTC Backgrounds, Inc. will be requesting information from various State and other agencies which maintain records about my history. These records include but not limited to driving, credit criminal, and civil history. I authorize any party or agency contacted by WTC Backgrounds Inc. to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. This authorization and consent shall be valid in original, fax, or copy form. Applicant Signature Date

4 POINCIANA PLACE CONDOMINIUM 6 ASSOCIATION, INC. THE BARCLAY BUILDING c/o Century Management Consultants, Inc., 2950 Jog Road, Greenacres, FL ~ Fax Background Information: APPLICATION FOR PURCHASE OR RENT This form must be completed in full for your application to be considered, and may be used for one person or husband & wife only. A separate application and fee will apply for each separate, unmarried adult applicant. All application spaces must be completed. I am applying to: Purchase OR Rent UNIT # YOUR NAME: Last First MI SPOUSE NAME: Last First MI CURRENT ADDRESS: HOME PHONE: CELL: WORK: Your current Landlord if renting: Contact Information YOUR Employer: Address: Phone: How long employed?: Title/Occupation SPOUSE Employer: Address: Phone: How long employed?: Title/Occupation Military Status: Active? Yes No Have you or your spouse ever been arrested for a felony? Have you or your spouse ever been convicted of a felony? Spouse: Military Status: Active? Yes No AUTHORIZATION OF RELEASE OF INFORMATION: Applicant(s) represents that all of the above information and statements on the application for purchase or rental are true and complete, and hereby authorizes verification of any and all information relating to residential history (rental or mortgage), employment history, criminal history records, court records, and credit records. This application must be signed before it can be processed by management. Applicant acknowledges that false or omitted information herein may constitute grounds for rejection of this application, termination of right of occupancy, and/or forfeiture of fees or deposits and may constitute a criminal offense under the laws of this State. NON-REFUNDABLE APPLICATION FEE Applicant(s) agree to pay $ for a non-refundable application fee. No oral agreements have been made. Applicant Signature Date Co-Applicant Signature Date

5 Date: Poinciana Place Condominium 6 The Barclay Building c/o CMC Management, Inc., 2950 Jog Road, Greenacres, FL ~ Fax NEW OWNER UNIT FILE ADDRESS: UNIT #, 3425 Via Poinciana # People who will occupy unit: Purchaser(s) Name(s): Other Occupants: Name: Relationship Name: Relationship ALTERNATE MAILING ADDRESS: Which address shall be used as your mailing address? (Check one box) Unit address or Alternate *HOME PHONE # CELL PHONE # * ALT/PHONE # Will you live in your unit full time? YES NO ~ If NO, will you be renting out your unit? YES NO If Renting Out, you must have potential renters fill out an application and submit it to the Management Company for approval. Vehicle #1 Tag # Year Color Make/Model Vehicle #2 Tag # Year Color Make/Model EMERGENCY CONTACT: Please indicate an individual who has a key to your unit and may be contacted to gain access to your unit in an emergency: Name: Address: Phone # Cell # *Your information shall be kept on file and may be used to contact you by the Association Board of Directors, Management, Police, or Emergency Rescue, however, the Association has no intention of sharing your private addresses, phone numbers or social security numbers as part of the official records.

6 Poinciana Place Condominium 6 The Barclay Building c/o CMC Management, Inc., 2950 Jog Road, Greenacres, FL ~ Fax NEW RENTER UNIT FILE Date: TERM OF LEASE: from to ADDRESS: UNIT #, 3425 Via Poinciana ~ # People who will occupy unit: Renter(s) Name(s): Other Occupants: Name: Relationship Name: Relationship *HOME PHONE # CELL PHONE # * CELL PHONE # Vehicle #1 Tag # Year Color Make/Model Vehicle #2 Tag # Year Color Make/Model EMERGENCY CONTACT: Please indicate a local individual who has a key to your unit and may be contacted to gain access to your unit in an emergency: Name: Address: Phone # Cell # *Your information shall be kept on file and may be used to contact you by the Association Board of Directors, Management, Police, or Emergency Rescue, however, the Association has no intention of sharing your private addresses, phone numbers or social security numbers as part of the official records.

7 POINCIANA PLACE CONDOMINIUM VI ASSOCIATION, INC. c/o CMC Management, Inc., 2950 Jog Road, Greenacres, FL ~ Fax CONDITION FOR LEASE APPROVAL In the event the Unit Owner is delinquent in the payment of assessments (which includes maintenances fees and any other charges owed to the Association) for more than thirty (30) days, the Association may notify the Lessee of the delinquency and in such event, the Lessee shall be obligated to commence paying all future rent payments to the Association, until the delinquent assessments and related charges are paid in full to the Association. At such time that the Lessee is paying his rent to the Association, the Unit Owner may not evict the Lessee for non-payment of rent. However, if the Lessee does not pay the rent to the Association as required herein, the Association shall have the authority to evict the Lessee. In such an event, the Unit Owner shall be obligated to reimburse the Association for the costs and attorneys fees incurred by the Association. **This form must be signed by both the Unit Owner and the Lessee** 3425 VIA POINCIANA, Unit # Term of Lease: Start date: End date: UNIT OWNER INFORMATION: Name PRINT Phone # Date: SIGNATURE TENANT/LESSEE INFORMATION: Name PRINT Phone # Date: SIGNATURE FOR SCREENING COMMITTEE USE ONLY: Screened by: PRINT NAME SIGNATURE DATE PRINT NAME SIGNATURE DATE

8 POINCIANA PLACE CONDOMINIUM VI ASSOCIATION BARCLAY BUILDING c/o Century Management Consultants, Inc Jog Road, Greenacres, FL ~ Fax FOR PURCHASERS: All purchasers of units in the Poinciana Place Condominium VI Association are subject to all the rules of the Declaration of Condominium Documents and its By-Laws. I have been provided with the Association s Governing Documents. I have also read and understand the Restrictions and Rules and Regulations of this Condominium, and promise to abide by them. Signature of Applicant Signature of Co - Applicant Signature of Witness Date FOR RENTERS: All renters of units in the Poinciana Place Condominium VI Association are subject to all the rules of the Declaration of Condominium Documents and its By-Laws. I have been provided with, have read and understand the Summary of Rules and Regulations. Signature of Applicant Signature of Co - Applicant Signature of Witness Date

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15 POINCIANA PLACE CONDOMINIUM 6 ASSOCIATION, INC. The Barclay Building c/o CMC Management, Inc Jog Road, Greenacres, FL CERTIFICATE OF APPROVAL FOR PURCHASE OR LEASE Pursuant to the Declaration of Condominium of Poinciana Place Condominium VI Association, Inc.; the Association, by and through its president, secretary or their designee certifies approval of the following transaction between: as Seller(s) or Landloards and as Buyer(s) or Lessees For the purchase or Rent of the following property which is located in Palm Beach County, Florida: Unit # located at 3425 Via Poinciana, Lake Worth, FL Located in Palm Beach County In Witness thereof, executed this day of, 20. Approved by: Print Name Signature Position Board of Directors Poinciana Place Condominium Assn. 6, Inc. Witness: Print Name Signature Position