Military Status Verification Form printable pdf download

SUMMIT VILLAGE, INC.

P.O. Box 4677

Stateline, NV 89449

MILITARY STATUS VERIFICATION FORM

ATTENTION UNIT OWNER (OR UNIT’S OWNER SUCCESSOR IN INTEREST):

Pursuant to Nevada Senate Bill 33 (SB 33), if you are a servicemember or a dependent of a servicemember, you may

be entitled to certain protections pursuant to SB 33 regarding the foreclosure of a lien for unpaid assessments. This

Form is being provided to afford you an opportunity to provide any information required to enable the Association to

verify whether you are entitled to the protections of SB 33.

Please take a moment to review and complete this form if you are a servicemember or a dependent of a servicemember.

Please return this form to the Association at the address listed above, along with your Military ID Number or any other

information you wish to provide to verify whether you are entitled to the protections of SB 33. If we are unable to

verify, you may be required to present the original Common Access Card or Uniformed Services ID Card to our office.

DO NOT MAKE A COPY.

The Association is required to verify whether a unit owner is a servicemember or dependent entitled to protections

under SB 33 and must make reasonable efforts to utilize all resources available, including conducting an online search

which is an actual cost to the Association. If you are NOT a servicemember or dependent of a servicemember and do

not wish to be assessed a charge for the Association to conduct a mandatory search before proceeding with the

collection process, please mark below indicating you are neither a servicemember nor a dependent.

PLEASE PRINT:

CHECK ONE THAT APPLIES: SERVICEMEMBER _____ DEPENDENT *_______ NEITHER ______________

FULL NAME _______________________________________DATE OF BIRTH________________________

TELEPHONE NUMBER ______________________UNIT ADDRESS_________________________________

MAILING ADDRESS ____________________________BRANCH OF MILITARY ______________________

MILITARY ID NUMBER ____________________DATE ENTERED INTO SERVICE ______________________

DATE SERVICE ENDED (If applicable) _______________________________________________________

DATE OF DEPLOYMENT (If applicable) ____________________DATE RETIRED (If applicable) _________________

I certify under penalty of perjury that the information provided herein is accurate and truthful.

________________________________________

______________________________

Unit’s Owner Signature

Date

* If you are a dependent of a servicemember, you may be entitled to the protections of SB 33 upon application to a court of

competent jurisdiction if your ability to make payments required by the Association’s lien for assessments is materially affected

by the servicemember’s active duty or deployment. If you are seeking the protections of SB 33, please provide the required

court determination.

-------------------------------------------------- (For Association Use Only, Do Not Write Below This Line)--------------------------------------

VERIFICATION:

_____ Servicemember Active Duty or Deployment

____ Dependent

______ Court determination of ability to make payments

____________________________________

______________________________

Association Representative

Date

rev. 8/21/17

Military Status Verification Form

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