Responsible Party Form

Loch Lomond Beach Club - Policy #6 Attachment A

OWNERS LISTED ON THE RECORDED DEED ON FILE AT LLBC:

The member listed below has been designated the responsible party for paying the annual
maintenance assessment, receiving the membership cards, paying any charges made against
the lot listed and receiving any correspondence sent by Loch Lomond Beach Club, Inc.

If you will be camping on your lot, please provide us with the signed Temporary Dwelling Permit

Verification by all listed owners - Please list each member, First and Last name

Clicking Submit indicates a signature

Form has been submitted