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Westerly Information & Acknowledgement Form

Closing Date:

Westerly Address: *

Home Phone:

Lot #:

CHECK ALL THAT APPLY: *

Just bought a home in Westerly

Leasing a Westerly property to tenants

Renting property from a Westerly homeowner

Current household updating form

PRIMARY HOMEOWNER/ RENTER INFORMATION

Full Name: *

Birthdate: *

Email: *

Phone: *

Full Name:

Birthdate: *

Email:

Phone:

ALL DEPENDENTS RESIDING IN THE HOUSEHOLD (age 23 & under)

Full Name:

Birthdate:

Full Name:

Birthdate:

Full Name:

Birthdate:

Full Name:

Birthdate:

Full Name:

Birthdate:

ALL OTHER PERSONS RESIDING IN HOUSEHOLD FULL TIME

(incl. dependents age 24 & over)

Full Name:

Birthdate:

Email:

Phone:

Full Name:

Birthdate:

Email:

Phone:

Full Name:

Birthdate:

Email:

Phone:

ACKNOWLEDGEMENT & SIGNATURE

By signing below, I acknowledge that all information above is correct. Should any of the information on this form change, I will notify the Westerly Community Lifestyle Manager in a timely manner.

Print Name:

SIGN DATE: *

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Westerly Information & Acknowledgement Form

(incl. dependents age 24 & over)

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Westerly Information & Acknowledgement Form

(incl. dependents age 24 & over)

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