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2021 OWNERS ANNUAL REGISTRATION FORM

Please complete to ensure we have the most current information regarding your property.

–FAILURE TO COMPLETE AND RETURN BY FEBRUARY 15, 2021 WILL RESULT IN LOSS OF AUTOMATED GATE CARD ACCESS & FINE–

2021 Registration Form

Date

Lot/Section: *

Pin # or Password: *

Owner # 1 Name: *

Owner # 2 Name:

Property Address (This is the physical address of the property in PEPOA): *

Mailing Address (If different from property/physical address):

Home Phone:

Work Phone:

Cell Phone:

Email

Is this a rental unit? : *

If yes, please select which type applies:

Short-Term

Long-Term

*Remember, all tenants must be registered using the tenant registration forms, which are available online or at the Administration Office

Please list all vehicle information registered (linked/cleared) to the property with and without gate cards

Gate Card #:

Make:

Model:

Color:

Year:

State:

Plate #:

Gate Card #

Make:

Model:

Color:

Year:

State:

Plate #:

Gate Card #:

Make:

Model:

Color:

Year:

State:

Plate #:

Gate Card #:

Make:

Model:

Color:

Year:

State:

Plate #:

Gate Card #:

Make:

Model:

Color:

Year:

State:

Plate #:

Please list all residents of the property

Name:

Relationship:

Name:

Relationship:

Name:

Relationship:

Name:

Relationship:

Name:

Relationship:

Name:

Relationship:

Name:

Relationship:

Name:

Relationship:

Please list all permanent guests allowed on the property

Name:

Relationship:

Telephone:

Emergency Contact?:

Yes

No

Name:

Relationship:

Telephone:

Emergency Contact?:

Yes

No

Name:

Relationship:

Telephone:

Emergency Contact?:

Yes

No

Name:

Relationship:

Telephone:

Emergency Contact?:

Yes

No

Name:

Relationship:

Telephone:

Emergency Contact?:

Yes

No

Name:

Relationship:

Telephone:

Emergency Contact?:

Yes

No

Please list all dogs on the property

Name / Type:

Tag #:

Name / Type:

Tag #:

Name / Type:

Tag #:

Name / Type:

Tag #:

Name / Type:

Tag #:

Name / Type:

Tag #:

The above information is accurate as submitted. Any and all changes to the above shall be submitted to the Administration Office within 48 hours. *

Agree

Signature Date: *

Homeowner's Signature: *

FOR OFFICE USE ONLY:

Tops Entered By:

Gatehouse Entered By:

Scanned By:

Owners Log Entered By:

Δ

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Public Safety: (570) 424-7047
Admin: (570) 421-4265

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