THE ROOSEVELT CONDOMINIUM ASSOCIATION, INC.

1255 Pennsylvania Avenue, Miami Beach, Florida 33139

APPLICATION FOR

PURCHASE OF RESIDENTIAL CONDO UNIT

Property Address: 1255 Pennsylvania Avenue, Miami Beach, Florida 33139 Unit #: _________

GENERAL INFORMATION:
  1. Name (Adult): __________________________________________________________________________

    2. Address: ______________________________________________________________________________

    City: ___________________________________________ State: ________________ Zip: ____________

  2. Name (Adult): (if applicable)_______________________________________________________________

    3. Address: ______________________________________________________________________________

    City: ___________________________________________ State: ________________ Zip: ____________

  3. Name (Minor): (if applicable)______________________________________________________________

EMERGENCY CONTACT:

Adult 1:

Name: _________________________________________________Relationship:________________________

Address: ________________________________________________Phone:____________________________

Adult 2:

Name: _________________________________________________Relationship:________________________

Address: ________________________________________________Phone:____________________________

INTENDED USE OF UNIT: (Please check one)

Primary Resident: ________________ Vacation Home: ___________________ Rental: __________________

Number and Type of Pets (if applicable): ________________________________________________________

To the best of my/our knowledge, all of the above information is true and correct. I/We have received and reviewed the Rules and Regulations for tenancy.

___________ ______________________________________________________________________

Date Buyer(s) Signature(s)

Home Phone: ________________________________ Work Phone: _________________________________

THE BUYER(S) HEREBY AKNOWLEDGE(S) THAT BUYER(S) HAS/HAVE BEEN PROVIDED A CURRENT COPY OF THE DECLARATION OF CONDOMINIUM, ARTICLES OF INCORPORATION OF THE ASSOCIATION, BYLAWS, RULES AND REGULATIONS OF THE ASSOCIAITON, AND THE QUESTION AND ANSWER SHEET MORE THAN THREE (3) DAYS, EXCLUDING SATURDAYS, SUNDAYS AND LEGAL HOLIDAYS, PRIOR TO EXECUTION OF THE PURCHASE CONTRACT.

Buyer: __________________________________________________ (Signature) Date: _______________