The County of Dufferin Homeownership - Annual Review and Acknowledgement Form
By signing this Annual Review and Acknowledgement Form you confirm that you remain in compliance
with the terms and conditions of the Loan Agreement with the County of Dufferin, dated
_______________________ (the “Loan Agreement”). Further, you acknowledge and understand that any false
statements will result in default of the Loan Agreement and may result in the issuance of notice by the
County of Dufferin that the Loan is immediately due and payable.
DC_______________: __________________________________________ (the “Property”)
I/We, the undersigned, acknowledge and confirm that:
° I/We continue to be in compliance with the terms of the Loan Agreement;
°
I/We continue to be in compliance with the terms of the Charge/Mortgage registered as security for
the Loan Agreement (the “Charge/Mortgage”);
° I/We continue to be the sole owner(s) of the Property;
° I/We continue to live at the Property as my/our sole and principal residence;
° I/We continue to have the required amount of insurance coverage on the Property in accordance with
the terms of the Loan Agreement and the Charge/Mortgage;
° I/We continue to pay all taxes on the Property and all such payments are up–to-date.
WITNESS:
Witness Signature
Witness (please print)
Signature
Name (please print)
Date
WITNESS:
Witness Signature
Witness (please print)
Signature
Name (please print)
Date
Please return the signed form to: The County of Dufferin at the address below.
The personal information collected on this form is collected under the authority of the Municipal Act for the
purposes of the home ownership program. For questions regarding the Municipal Freedom of Information and
Protection of Privacy Act, please contact the Manager of Housing Services at 519-941-2816 x2020.
