Request for Board Review

Lorton Valley Homeowners Association

(PLEASE PRINT CLEARLY)

Fee Waiver Request Form

Association Name: ________________________________________________

Homeowner Account #: ______________________
Owner Name(s): ________________________

Property Address (include unit number if applicable):
___________________________________________________________________

Telephone #: _____________________________
Email: ________________________________

Please Check One:
[    ] Late Fee Removal Request    or   
[    ] Other Charge Removal Request

Total Late Fees Amount: $_____________   
Total Other Charges Amount: $_____________

Type of Other Charges: ________________________________

Please use the space below to explain why you believe the Board should waive the above referenced fee(s):

You are responsible to continue making payments while your request is being reviewed.  Additional late fees and collection fees may be added in accordance with your Association’s collection policy. The Board of Directors will be presented with this request at the next regularly scheduled board meeting. After the Board review, you will receive written notification of the Board’s final decision.  Submitting a request does not constitute approval, as all waivers must be approved by the Board of Directors.

Signature: _____________________________________________     
Date: __________________

Please return this form to your community manager

FOR INTERNAL USE ONLY

Manager Signature: ___________________________________________     
Date: ____________________

Board Denied – notice sent by Manager on: _______________________________________

Board Approved (Attach Board Approval) – notice sent by Manager on:                      

Account Adjusted & Cleared: ___________________________________________