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<br />EXHIBIT 15 <br /> <br />c <br /> <br />APPLICATION FOR RECOGNITION AS A SPECIAL CATEGORY <br />TENANT IN A CONDOMINIUM CONVERSION <br /> <br />1. Date prepared: <br /> <br />2. Prepared by: <br /> <br />3. Tenant Name: <br /> <br />4. Address: <br /> <br />Phone: <br /> <br />5. Household composition (list all household members, including yourself): <br /> Name Age Sex Relationship <br />(1) <br />(2) <br />(3) <br />(4) <br />(5) <br />(6) <br /> <br />6. Please complete, if you are claiming status as a disabled person. Does any <br />member of the household have a physical, emotional, or mental disability? <br />DYes DNo <br />If yes, please describe the condition, including: <br /> <br />a. Is the condition temporary? D Yes D No <br />b. Is the condition permanent? DYes D No <br />c. Does the disability require the use of external aids, such as: <br />D Wheelchair D Cane D Walker D Other, please describe: <br /> <br />d. Are you under a doctor's care? DYes D No <br />e. Do you require another person's assistance? DYes D No <br />f. Does the disability impair your ability to move about without pain? <br />DYes D No <br />g. Has a government agency made a determination of your condition? <br />DYes DNo <br />h. Please describe the disability and explain whether the disability prevents <br />or makes it difficult to carry out regular activities of daily living, such as <br />housework, shopping, meal preparation, or personal care. <br /> <br />Exhibit 15: Application for Recognition as a Special Category <br />Tenant in a Condominium Conversion <br /> <br />Page I of 3 <br />