HOLIDAY HEIGHTS HOMEOWNERS ASSOCIATION
96 Prince Charles Drive
Toms River, NJ 08757
(Housing for Older People Act)
The Housing for Older Person Act was signed into law on December 28, 1995 by President Clinton. The HOPA provides housing for older persons and is intended for occupancy by at least one person 55 years of age or older per unit. It requires that periodically information must be collected and verified with the age of all residents. Under NJ Law, a letter regarding age is required to be filed with the deed.
It is mandatory that you complete this survey and return to the Association office immediately.
H Homeowner Renter (Check One) BADGE#_____________
Homeowner/Renter Name (s) Street Address
_____________________ _____ _________________ ____________________________________
City State Primary Phone # Emergency Contact Phone #
*Should not be the same as the
primary phone #
_____________________ __________________ ____ _________ ________________________
Street Address City State Zip Code Alternate phone #
Total number of people living in your home. ________ including live in assistants, housekeepers, aides, etc.
Please list below the name (s); age and birthdate of all residents:
NAME AGE BIRTHDATE
Person#1____________________________ _________ __________________
Person#2____________________________ _________ __________________
Person#3____________________________ _________ __________________
Person#4____________________________ _________ __________________
I/We certify this form to be an accurate statement of the number of persons living in my home with their accurate birthdates. Under penalty of perjury, I/We declare that the above information is true, correct and complete.
____________________________ _____________________________ ________________
Homeowner/Renter Signature Homeowner/Renter Signature Date
Filing of this document is required by Federal and State Law.