96 Prince Charles Drive  
Toms River, NJ
08757
(732) 244-8686
fax (732)244-1447
 
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WELCOME TO HOLIDAY HEIGHTS
An Age Restricted Active Retirement Community

HOPA FORM

HOLIDAY HEIGHTS HOMEOWNERS ASSOCIATION
96 Prince Charles Drive
Toms River, NJ  08757
732-244-8686

HOPA SURVEY-2018
(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.

HOPA QUESTIONNAIRE

forms1forms2_____      Homeowner     _____      Renter (Check One)  
BADGE#_____________

Please print:

___________________________________________     ______________________________________
Homeowner/Renter Name (s)                                                           Street Address

_____________________  _____   _________________    ____________________________________
City                                  State      Primary Phone #         Emergency Contact  Phone #
*Should not be the same as the
primary phone #
Alternate Address:

_____________________    __________________   ____   _________     ________________________
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 decare 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.

 

 
 

 
 
           
   

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