OAKS NORTH COMMUNITY CENTER

“A Senior Citizen Housing Development”

12578 Oaks North Drive, San Diego, California 92128-1699

Telephone (858) 487-0120 § Fax (858) 487-5328

TO: All Oaks North Residents

FROM: Board of Directors

SUBJECT: Owner/Tenant Age Verification Form

As you know, Oaks North is housing for older persons, or "A Senior Citizen Housing Development". This means the Oaks North CC&R's restrict occupancy, residency and use of homes within Oaks North on the basis of age or familial status. Civil Code Section 1368 requires senior communities such as Oaks North publish the following statement regarding such restrictions:

The age restrictions that apply to Oaks North are enforceable only to the extent permitted by Civil Code Section 51.3 which provides that residents of senior communities include senior citizens (persons 55 or older) or "qualified permanent residents", as that term is defined below, or compensated providers of live-in, long term or hospice care to seniors.

A "qualified permanent resident" is someone who satisfies both of the following requirements:

(a) is 45 years of age or older, or a spouse, co-habitant (persons who live together as husband and wife or persons who are domestic partners within the meaning of Section 297 of the Family Code) or someone providing primary physical or economic support to a senior; and

was residing with the senior citizen prior to the death or dissolution of marriage or upon hospitalization or other prolonged absence of the senior citizen.

(b) is a disabled person or person with a disabling illness or injury who is the child or grandchild of the senior citizen who needs to live with the senior citizen because of the disabling condition.

Temporary residence by persons less than 55 years of age (guests) is permitted for a period not in excess of sixty (60) days in any twelve (12) month period.

To qualify as a permitted health care resident, the service provided must be substantial in nature and must provide assistance with either necessary daily activities or medical treatment or both.

In order to meet the federal and state requirements for senior communities, the Center must maintain information on residents living in the community. State law requires information on each resident, and federal law requires senior communities to be able to demonstrate that at least 80% of the occupied units are occupied by at least one person 55 years of age or older. In order to meet this requirement, the Association performs annual surveys of residents’ ages and related information.

Please fill out the “Owner/Tenant Age Verification Form” completely, attach proof of age and return it to the Community Center in the enclosed envelope. The completed form will be held in confidence, and the information contained thereon will not be disclosed unless required in connection with a challenge to the Center's senior status.

If you have any questions, please contact the Community Center at (858) 487-0120. Thank you for your cooperation and assistance in this matter.

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OAKS NORTH COMMUNITY CENTER, INC.

“A Senior Citizen Housing Development”

12578 Oaks North Drive, San Diego, California 92128-1699

Telephone (858) 487-0120 § Fax (858) 487-5328

OWNER/TENANT AGE VERIFICATION FORM

Every owner of, or person residing in, a home in Oaks North MUST ANNUALLY complete an age verification form to certify his or her eligibility to reside in Oaks North, a senior community. All residents must attach proof of age (copy of driver's license, birth certificate, etc.). Whenever there is a new resident in the home, a new age verification form must be submitted. The Community Center reserves the right to verify any information given below:

¨ I own and reside in the home identified below.

¨ I am a renter or lessee of the home identified below

¨ My spouse (or co-habitant) also resides in the home identified below. His/her name and date

of birth (please attach proof of age) are as follows:

___________________________________________________________________

Name Date of Birth

¨ I own BUT DO NOT RESIDE in the home identified below. All residents of the home identified below are listed by name as follows: (then proceed to PART 2 on page 3)

_______________________________________________________________________

________________________________________________________________________

¨ By checking this box and signing under Part 2 on page 3 of this form (skipping Part 1) I certify that there have been no changes in ownership of and/or residency in the home identified below since the prior Owner/Tenant Age Verification Form was submitted.

PART 1 SECTIONS A, B OR C MUST BE COMPLETED BY ALL RESIDENTS

(Both Owners and Non-Owners)

NON-RESIDENT OWNERS SHOULD SKIP TO PART 2 ON PAGE 3

A. ¨ I am a person 55 years of age or older, so I qualify for residency as a senior citizen. (Skip to PART 2 on page 3)

B. ¨ I am not a person 55 years of age or older, but I qualify for residency as a permitted health care resident because I provide paid live-in, long term or terminal (hospice) health care to _______________________________________________ who resides in the home. (Skip to PART 2 on page 3)

C. ¨ I am not a person 55 years of age or older, but I qualify for residency as a qualified permanent resident, because of the facts I have checked under C.1 and C.2 or C.3 on page 3:

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C.1 ¨ ______________________________________________ is the person residing in the home who is 55 or older OR

¨ ______________________________________________was the person 55 or older who resided in the home prior to (mark 1 box below):

A. ¨ his/her death; OR

B. ¨ his/her hospitalization, OR

C. ¨ his/her prolonged absence from the property; OR

D. ¨ the dissolution of marriage

C.2 AND BECAUSE (Mark at least 1 box in A, B, or C ) then proceed to PART 2 )

A. ¨ I am 45 years of age or older; OR

B. ¨ I am the spouse or co-habitant (persons who live together as husband and wife or persons who are domestic partners within the meaning of Section 297 of the Family Code) of the person identified in C.1 above; OR

1. ¨ I am providing primary physical or economic support to a resident of the home;

C.3 ¨ I am not a person 55 years of age or older but I qualify because I am a disabled person or a person with a disabling illness or injury who is the child or grandchild of the senior citizen or qualified permanent resident who needs to live with the senior citizen or qualified permanent resident because of the disabling condition.

PART 2 CERTIFICATION AND SIGNATURE

IF I AM CURRENTLY A RESIDENT OF OAKS NORTH, I HAVE ATTACHED OR PREVIOUSLY SUBMITTED PROOF OF AGE FOR MYSELF AND MY SPOUSE OR CO-HABITANT (IF APPLICABLE) TO THIS FORM AND I CERTIFY THAT IT IS (THEY ARE) A TRUE AND CORRECT COPY OF THE ORIGINAL DOCUMENT(S).

I DECLARE UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE STATE OF CALIFORNIA, THAT THE FOREGOING STATEMENTS ARE TRUE AND CORRECT.

EXECUTED THIS _______ DAY OF _____________, _________,AT____________,____________.

Date Month Year City State

________________________________________________________________________________

Signature Address of Property

________________________________________________________________________________________________

Printed Name ONCC Membership Number

PLEASE BE ADVISED THAT THE INFORMATION CONTAINED IN THE QUESTIONNAIRE WILL BE MAINTAINED IN CONFIDENCE BY THE COMMUNITY CENTER TO THE GREATEST DEGREE POSSIBLE. YOUR COOPERATION IS ESSENTIAL TO OUR CONTINUED RIGHT TO OPERATE AS A SENIOR COMMUNITY, AND WE THANK YOU.

IF NOT PREVIOUSLY SUBMITTED - DO NOT FORGET TO ATTACH YOUR PROOF OF AGE

(Except Non-Resident Owners)

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