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I/We the undersigned having read and understood the rules-regulations-rates hereby acknowledge receipt of the aforementioned, And agree to same. I/We also acknowledge; that upon default of payment; contravening of any rules; not acting in 'Good Faith' in any matter whatsoever; that Lilac Lodge Trailer Park Ltd. at their sole discretion has the authority to Evict and or take any remedial action deemed necessary and that I/We will be responsible for any costs incurred By them. We further acknowledge, accept and understand that the common areas and staff of the property may at any time or times be under both video and or audio surveillance.

I/We the undersigned hereby agree to the aforementioned, and acknowledge receipt of copy.

Signature: _____________________________________  Dated: ____________________  20 ___

Name: _______________________________________  Lot# ______________________

If there are any changes to your address or telephone status, please fill them out.

Address: _______________________________
Telephone: _____________________________
Drivers License: _________________________________

Please return and or hand in this acknowledgement.