Residential Primary Residence Form

RESIDENTIAL PRIMARY RESIDENCE FORM

Parties and Property

Owner/Authorized Agent Name:

Resident Name:

WHEREAS

WHEREAS, Owner/Authorized Agent represents that Owner holds legal title to or authority over the Property identified above; and

WHEREAS, Resident represents that Resident occupies or intends to occupy the Property as Resident's primary, permanent residence and makes this declaration for purposes of establishing domicile, residency benefits, occupancy status, or verification required by Owner or other authorized parties; and

WHEREAS, the parties desire to set forth the terms and attestations governing that primary residence determination.

Declaration of Primary Residence

Resident hereby declares under penalty of law that Resident's primary residence is the Property located at the address above and that Resident's intent is to make the Property Resident's permanent principal residence.

Date of occupancy (first day Resident established residence at Property):

Number of persons occupying the Property:

Resident affirms that Resident's mailing address for official communication is:

Scope of Occupancy

The parties agree the scope of occupancy and responsibilities is as follows. Describe permitted uses of the Property, maintenance responsibilities, number of authorized occupants, and any limitations on use:

Payment Terms (If Applicable)

Monthly amount due in connection with occupancy (if any):

Payment schedule and due date:

Late fee for overdue payment (percentage or flat amount):

Method(s) of payment accepted:

Term and Termination

Term of this declaration and agreement begins on:

Term ends on (if applicable; otherwise indicate "Indefinite"):

Notice period required to terminate this declaration:

Confidentiality and Use of Information

The parties acknowledge that personal information supplied in this form (including mailing address, occupancy dates, and contact information) is confidential and will be used only for verification, recordkeeping, administration of occupancy entitlements, and as required by law. Neither party will disclose confidential information to third parties except as necessary to enforce rights under this form or as required by governmental or judicial process.

Governing Law

This declaration and agreement is governed by and construed in accordance with the laws of the State of , without regard to conflict of laws principles.

Certifications; Remedies for False Statement

By signing below, Resident certifies under penalty of law that the statements in this form are true and correct to the best of Resident's knowledge. Resident acknowledges that knowingly making a false statement on this form may subject Resident to civil or criminal penalties and may constitute a material breach of any occupancy obligations.

Resident authorizes Owner or Owner's designee to verify residency claims by contacting third parties, inspecting the Property for occupancy, or requesting documentation such as utility bills, driver's license, tax records, or other evidence of residency.

I certify that the Property is my primary, principal residence.

I intend to maintain the Property as my permanent residence for the foreseeable future.

Entire Agreement

This form constitutes the entire agreement and declaration between the parties regarding the subject matter herein and supersedes all prior oral or written representations or agreements. Any amendment must be in writing and signed by both parties.

Additional Remarks

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