I desire to purchase one of the affordable Forest Village Condominium homes for $158,483. 
I understand that the priority of purchasers will be selected by public lottery. If selected by lottery, I shall have ten (10) days to sign a purchase and sale agreement with a $2,000 earnest money deposit that is subject only to: 1) qualifying as a purchaser under Wells Ordinance Chapter 175 with respect to age, income and Wells residency; and 2) thirty days to obtain satisfactory mortgage financing. Determinations as to qualifications and purchase contract decisions shall be made by the Declarant/Seller in its sole discretion.

Name:

Address:

Address 2:

City:

Zip:

Telephone:

E-Mail:

I certify that

1. My spouse or I are over 55 years of age.  I understand that I will be required to provide a birth certificate as part of the final purchase process;
2. My annual income for the 2004 tax year, as reflected on my federal tax return, was less than $45,950. I understand that I will be required to provide my 2004 federal tax return as part of the final purchase process; and
3. I have been a Wells resident for at least six months in 2005. I understand that I will be required to provide a copy of my deed, tax bill or lease as part of the final purchase process.