�dditional Resident

PLEASE READ ALL FORMS AND COMPLETE THE

APPLICATION IN ITS ENTIRETY.

1
 4H
UNIT#:_____________ BAY NORTH
BUILDING: _________
Alfonso Lopez Giro
APPLICANT NAME: __________________________________

APPLICANT SIGNATURE: ______________________________

954-842-1578
CONTACT NUMBER(S): _______________________________
[email protected]
EMAIL: _____________________________________________

• SCREENING FEE: $150.00 PER PERSON OR $150.00 PER MARRIED COUPLE

• INTERNATIONAL SCREENING FEE (INCLUDES CANADA): $175.00 PER PERSON OR
$275.00 PER MARRIED COUPLE
• APPLICANTS MUST PROVIDE A COPY OF THEIR DRIVER'S LICENSE AND/OR PASSPORT
WITH VALID VISA OR I-95
• APPLICANT MUST PROVIDE A LETTER FROM THE UNIT OWNER AUTHORIZING THE
ADDITIONAL RESIDENT

PLEASE KNOW THAT IT MAY TAKE UP TO 15 BUSINESS DAYS TO RECIEVE APPROVAL

FROM THE ASSOCIATION. DURING THAT PERIOD NO INFORMATION WILL BE
DISCLOSED. YOU MUST WAIT TO BE CONTACTED BY THE ASSOCIATION.

OCCUPANCY
• NO UNIT SHALL BE USED FOR ANY PURPOSE OTHER THAN A SINGLE-FAMILY
DWELLING
• NO STUDIO UNIT SHALL BE OCCUPIED BY MORE THAN TWO INDIVIDUALS
• NO ONE BEDROOM UNIT SHALL BE OCCUPIED BY MORE THAN THREE INDIVIDUALS
• NO TWO BEDROOM UNIT SHALL BE OCCUPIED BY MORE THAN FOUR INDIVIDUALS
• NO THREE BEDROOM UNIT SHALL BE OCCUPIED BY MORE THAN SIX INDIVIDUALS

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 RATES FOR RESIDENTS

Check or credit card only

No Refunds
Parking fees
• Studio I One bedroom: One (1) free RCA Parking or Assigned outdoor Parking if available.
• Two/ Three bedroom: One (1) fr�e garage owner parking (if available)
• Second car $420.00 Annual Fee
• Third Car $840.00 Annual Fee
• Motorcycle $210.00 Annual Fee
• Nurses parking fee $30.00/month
• Seasonal parking (100 days or less) $75/Monthly
• Intermediate term (101 days to 364 days) $60/Monthly
All parking must be paid by the 30th of January every year. Occupants who do not pay their
parking fee by the 30th of January will forfeit the parking spot and the parking spot may be
reassigned.
Yearly parking (January -December)
• Second car: $420.00
• Third car: ;$840.00
• Motorcycle: $210.00

All yearly parking must be paid in advance by the 30th of January

(Unit owners must surrender the parking sticker to the office in order for the tenant to receive
parking free of charge)

Miscellaneous Fees
• Transponder: $100.00
• Medeco key: $100.00
• ID card: $20.00
• Condo document book:$75.00
• Towels: $40.0O each

RENTERS MUST SUBMIT A ONE MONTH SECURITY DEPOSIT WITH THE APPLICATION
• Screening fee $150.00
• International Screening fee (Including Canada) $175.00 per person or
$275.00 per married couple
• Service Elevator reservation for move in and move out fee $100.00
Notes
1. Parking spaces are not deeded and are assigned by the management office.
2. Parking spaces can only be occupied by the vehicle registered to that spot.
3. Charges for seasonal and intermediate term lessee's will be applicable
whether a space is specifically assigned or common area parking is
designated (Applies to additional spaces only).

Initials:_____________ Initials_____________
3 Updated 10/22/19
 Owner/Tenant/Lease Applicant Disclosure and Release Form

As part of the application process for Owner/Tenant Rental/Leasing purposes from _____ , I understand that they and/or its
agents may conduct an investigation of my personal information. The investigation might include, but is not limited to names
and dates of previous/current addresses and/or employment, database search, criminal history records from state, federal
and other agencies, bankruptcy records, and credit history. I understand that these records may be used for the eligibility of my
Tenant/Lease application. I authorize without reservation the full release of these records for SARMA and/or its agents to obtain
information.

I also release and discharge SARMA, and all of its agents and associates, any expenses, losses, damages, liabilities, or any other
charges or complaints for the investigative process. I also authorize the full release of the information described above,
without any reservation, on behalf of this application for Tenant/Lease verification purpose. I also certify that all information
provided is correct ·on the application to the best of my knowledge. Any false statements provided will be considered just
cause for cancellation of my Rental/Lease application.

SARMA will upon request, supply a copy of the credit report and my rights under the Fair Credit Reporting Act. SARMA can be
reached at 1-800-955-5238.

Credit/Criminal/Certification Release Authorization

I hereby authorize SARMA to obtain a credit report in connection with my application at_________________. I understand that my
credit report and the information therein shall be used in compliance with the Fair Credit Reporting Act or appropriate
regulations. I also understand that I have a right to obtain a copy of my own credit report and can dispute any information.

Alfonso Lopez Giro

I, _______________________________________ hereby authorize, without any reservation, any database/bureau
contacted by SARMA to obtain the above credit/other report type information.

PLEASE PRINT:

Lopez Giro Alfonso

Applicant (Last Name) (First Name) (Middle Initial)

Applicant (Maiden Name/Former Name)

1965 S. OCEAN DR. apt.4H , Hallandale, Fl. 33009

Current Address, City and Zip Code

Former Address, City and Zip Code

3149 John P. Curcie dr., Hallandale, Fl. 33009

Current Employment, Address, City, State and Zip Code/
N/A 10/01/1991
SSN (Applicant) Date of Birth (Applicant)

4621156-0 International Driver's License

Driver License Number State of Issue

05/03/2022
Signature (Applicant) (Date)

4
 05/03/2022
Date: _____________

Personal Information

Alfonso Lopez Giro

Applicants Name: __________________________ 10/01/1991
Date of Birth: ___________

4621156-0
Driver's License Number:____________________ International Driver's License
State: _____________________

SINGLE
Marital Status:__________________

Other occupants under the age of

18: Name: ___________________ Age: Relationship:______________________
Name:_________________________ Age: Relationship:_______________________
Name: ________________________ Age:

DO Y0U OWN PETS: YES NO

(Dogs are prohibited)

Emergency contact:
---------------- Phone number:-------'----'-----
Name: CLAUDIO SCELLATO 786-443-2973

Residential History

-----------------------
Present Street Address: 1965 S. OCEAN DR. apt.4H
Florida
State: ________ Zip: _33009 N/A
____ Payment:---------,--
Landlords Name; N/A Phone: ---------
N/A
-----------------------'--
Reason for Moving: FAMILY OF THE OWNER

Previous Street Address: -------------- ------�

Tristan Narvaja 1513 # 807, Montevideo
State: Uruguay N/A
. Zip: _____ Payment: ________ _
Landlords Name: N/A Phone: ---------
xxxxxxxxxxxx N/A
954-842-1578
Reason for Moving: _____________________
FAMILY OF THE OWNER .....:__

5
 Employment History

Wood's Professional Service LLC

Present employer: ___________________________ _
Pos ition: _____________ Supervisor: _____________
Workshop Manager
------------------ -----------
Address: 3149 John P. Curcie dr., Hallandale, Fl. 33009 Phone: 954-274-6770
Date of Employment: _________

Gross Annual Salary (including fees, tips, commissions and bonuses) 52.000.-
$ _______
Other income you want to disclose N/A
$ ______ _

Previous employer: __________________________

N/A ( Uruguay ) _
pe so
Positio n:----------'------ Su rvi r: ___________;_____
Address: ------------------ Phone: ---------'-----
Date of Employment: Gross Weekly Salary: _________

Bank Information

-----------------
Bank Name and Branch: BANK OF AMERICA
Bank Name and Branch: -----------------
Credit References

Creditor: --------
Creditor:
N/A
Account #:
N/A
Account#: -------- Mo Payment: • N/A
Mo Payment: _____
____
.;__.

Creditor: Account#: Mo Payment: _____

Vehicles

2015 Make: FORD Model: 4D

Year: --- 79BLIE Registered
---- ---- Tag: ---- � to: -'-personal
-----
Year: Make: Model: Tag: Registered to: __;___ _ __
Year: Make: Model: Tag: Registered to: _ ____

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 4H Building: ___
Unit#: _____ BAY NORTH
______

Applicant has submitted the sum of $100.00 which is non-refundable payment for a background
screening processing charge of the applicant. Such sum is not a rental payment or security deposit.
This amount will be retained by management to cover the cost of processing the appHcation.

It is understood and agreed between the parties that in the event this application for the above
reference apartment is rejected by The Hemispheres Condominium Association the said sum so
received. as security deposit shall be returned to the applicant without interest.· It is thrther
understood and agreed that in the event that said application is approved and accepted by The
Hemispheres Condominium Association then the said amount received below shall be applied on
the security deposit so called for the lease entered into between the parties. It is further understood
and agreed by the parties that in the event that said application is approved and acc�pted by The
Hemispheres Condominium Association and applicant refuses to enter into a lease agreement
for the period of time as called for in the applicants application then the sum so received shall be
retained by The Hemispheres Condominium Association to serve as liquidation damages it will
suffer by reason of applicants ·falling to enter into residency of that above stated depa1iment,
but the acceptance or rejection by the applicant shall remain with the sole discretion of
The Hemispheres Condominium Association. I hereby authorize and give the right to verity
reasonable means the application to exercise at its sole discretion as to whether to reject this
application and/or terminate any lease which may be entered into between the parties pursuant
to this application, whether during the term of the lease or any extensions or renewal thereof ifthe
applicant has made any false statement or misrepresentation what so ever in the application.

Applicant has deposited the sum of$ _____ which is to be applied to the security deposit in
reference to the above apartment unit.

Applicant's signature: ___________________ 05/03/2022

Date: ______________

7
 "SUMMARY OF
IMPORTANT RULES TO ABIDE BY"
• A unit owner is only allowed one ( 1) rental per year after completion of
one year of ownership and the absolute minimum rental is for 3 months.
Illegal renters will not be tolerated!
• Barbecuing is not allowed on the balconies or in the common areas. We
have a BBQ located in the Bay side area for residents to use.
• Satellite dishes shall be installed within the boundaries of the ten-ace (or
balcony) area only with written authorization from the association or the
General Manager.
• Clothing or towels should not be hung on balcony railings.
• Beach umbrellas are not allowed on balconies.
• Sliding glass doors and windows must be closed at all times. Leaving them
open will cause air conditioning problems. Moisture and mold buildup
inside the residence and cause disturbances to other units. Importantly,
open doors and windows increase energy cost to all unit owners.
• Proper attire, such as shirts & shoes, are required in the Tower Lobbies.
Wet bathing suits are prohibited in the Tower Lobbies. Residents and
guests with bathing attire must use lower lobbies.
• Everyone must read and follow the "Pool Rules" posted by the pool
entrances such as:
1. No food or beverages (water allowed) except in designated areas.
2.One fitted towel covering the full length of the chaise lounge must be
used. All new owners and renters, must purchase from the association a
minimum of two towels upon registration.
3. Float devices, beach balls, snorkels, scuba gear, fins, etc., are prohibited
except personal floating devices that attach completely around the body
and are U.S. Coast Guard approved.
• Children under 12 years of age must be accompanied by an adult in the
pool area; and children under 5 years of age in the pool must be actively
supervised by an adult in the pool with the child.
• No jumping allowed in the pool area.
• Anyone incontinent, in diapers or training pants are not permitted in any
pool unless they are wearing a leak proof swimmer's diaper.
• Individuals using the pool area shall have their access cards readily
available to identify themselves. Guest must be accompanied by a resident
or unit owner.
• Access cards must be used only by owner of the card. Anyone caught using
someone else's card will have card confiscated.
 • All cars and motorcycles must be registered with the parking office which is
open Monday to Friday 8 am to 4 pm. Cars an-iving during the weekend or
after office hours must register their car with the security department in any
of the lobby entrances to obtain a "courtesy pass."
• All cars must park "head in" only.
• Any unit owner with overnight guests must notify the office ahead of time
and provide the office with the names and length of stay.
• No dogs allowed on the premises.
• Unit owners are responsible for their visitors and tenants.
• There shall be no solicitation by any individual, company or organization on
the Hemispheres' premises. Under door distributions of any kind are strictly
prohibited, except for informational notices authorized by the General
Manager or Board of Directors.
• No littering by residents or their guests on our premises or the beach.
• All renters and visitors must be made aware of the rules and they must obey
them.
• The association publishes a monthly newsletter which provides information
from Management and the Board of Directors as well as a monthly calendar
of events. The newsletter also appears on the Hemispheres website at
www.thehemispheres.com
• Community Channel 800 l provides information of upcoming events and
reminders.

NOTE: A book with a complete set of rules and regulations is available at the
office.

I acknowledge that I have read the above "Summary of Important Rules'' and will
abide by them.

Signature:________________________ 05/03/2022
Date:___________________
 HOLD HARMLESS AND INDEMNIFICATION FOR HEMISPHERES
PARKING LOTS AND GARAGES

Alfonso Lopez Giro of unit ________

_________________ 4H shall indemnify and hold harmless, the
Hemispheres Condominium Association, Inc. and all of its agents and
representatives from all suits and claims of any character whatsoever which
arise from driving/parking or theft of their vehicle/motorcycle or any method of
transportation in the garage, or the contents of any vehicle/motorcycle or
rnetpod of transportation, brought on to the property, whether insured or
uninsured. The Hemispheres Condominium Association is not responsible for
the contents or the vehicle/motorcycle or any method of transportation while
on the property. The occupant understands that they are waiving any claims to
any theft or property damages, by any means and for any reason or from any
claims arising any maintenance, theft, loss or damages to the occupant, their
guests or invitees or anyone corning on to the property for the occupant.
Alfonso Lopez shall be liable for all personal and property damages of any
______________
character resulting from any act, omission, negligence, or misconduct in the
garages or parking areas for the Association.

Alfonso Lopez Giro 05/03/2022

OCCUPANT NAME DATE

4H BAY NORTH
UNIT NUMBER/BUILDING