Samoset Condominium Associaiton

2011 SAMOSET AT WINNIPESAUKEE CONDOMINIUM ASSOCIATION REQUEST FOR PET REGISTRATION C/o Evergreen Management, Inc., 67 Water St., Suite 203, Laconia, NH 03246 (P) 603.528.3044 (F) 603.524.1331 Email: [email protected]

To complete this form, save the file to your computer desktop, click in each form field and type, click in appropriate checkboxes, save again, and finally email as an attachment to the email address above. Alternatively, print the completed form and fax to the number above. Please complete this application fully, email or fax all requested materials, and return for submittal to the Board of Directors for review and action on. Please complete one (1) request form for each pet.

Unit Owner(s): Unit Number:

Type of Pet: Dog Cat Other: please specify

1. Description of Pet:

Name of Pet: Color:

Breed: Size:

REGISTRATION INFORMATION City/Town, State of Registration: Registration Tag Number: Registration Expiration Date:

2. Certificate of Vaccination for Rabies/Distemper

Please scan certificate and email as an attachment along with this file, or fax/mail a copy of the certificate to the office.

3. Signature

I have completed this application, enclosed all necessary certificates and understand I (we) must comply with the Condominium Rules and Regulations currently in effect and as amended. I (we) also understand the Board of Directors shall have the power to revoke permission to have a pet for violations of the Associations rules.

Signature of unit owner has been received by checking this box:

Unit Owner completing this form: Date form completed:

Unit Owner’s Email Address:

To be completed by Board of Directors. A completed copy will be returned to Applicant.

Board Action: Approved Denied Date: Pet Registration Request Form – 2011, 02.23.11