Revised 1/6/10 Form 653
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY - REAL ESTATE DIVISION
OFFICE OF THE OMBUDSMAN FOR COMMON-INTEREST COMMUNITIES AND CONDOMINIUM HOTELS
3300 W. Sahara Ave., Suite 325 * Las Vegas, Nevada 89102
(702) 486-4480 * Toll free: (877) 829-9907 * Fax: (702) 486-4520
http://red.nv.gov
LIMITED PURPOSE ASSOCIATION CREATED AS A RURAL AGRICULTURAL
RESIDENTIAL COMMON-INTEREST COMMUNITY ANNUAL REGISTRATION
Name of Association: ___________________________________________________________________________
Secretary of State entity number: ________________________ Secretary of State file date: ___________________
Association’s Physical Address: _________________________________________________________________
Association’s Mailing Address: _________________________________________________________________
Association’s Telephone Number: ____________________________ Fax Number: ______________________
Management Company (if any) _________________________________________________________________
Management Company’s address: _______________________________________________________________
DESCRIPTION OF ASSOCIATION PROPERTY
Units conveyed/closed to date: _______ Units declarant reserves/reserved the right to convey:___________
Is the association a: (check one) □ Single Family Dwelling □
Manufactured Housing
Name of person completing form (print) ______________________________________ Title: _____________________
Signature: ________________________________________ Date signed: ____________ Mgr. License #_____________
For office use only
Physical address:
Number & Street
City / State / Zip Code
E-mail Address
(Optional)
Please use a separate sheet of paper for additional board members and attach is to this form, if needed.
Processed By: _____________ Date Processed: __________________________________ Date Received _____________________________________
