SOLE OWNER MEMBERSHIP CARD

(Please print when filling in the blanks)

I, _______________________________________ acknowledge that I am the sole

owner of SUBDIVISION ______ BLOCK _____ LOT ______, Bella Vista Village, and

am requesting  a  membership card for _______________________________, and

affirm that we are living  together as a single family household. (Must provide copy of

Drivers License or Picture ID  with same address as Property Owner in order to

qualify  for membership as stated in BP  3.06)

It is understood that the additional card will not be automatically issued each year, but

only upon request. It is further understood that in the event, at any time during the

year,  we no longer reside together as a single family household, the membership

card issued  to _______________________________ will be returned to the POA

office. It is also understood that as sole owner of the referenced property, only my

(Primary Owner) dependents are entitled to membership cards upon request.

_________________________________                    ___________________
                Owners Signature                                                          Date

Requests should be dropped off at the POA General Office at Town Center or mailed to:

Bella Vista Property Owners Association
Attn: Membership Services
101 Town Center
Bella Vista, AR. 72714

Phone: (479) 855-8000
Fax: (479) 855-8006

01/26/2007