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Please fill in all fields in this section. If a field does not apply to you then, please enter “N/A” for not applicable.
If you do not meet the residency requirement (currently living in Ozaukee County for at least 1 year), indicate the name and address of an immediate relative who does meet the residency requirement. Please fill in all fields in this section. Please note, if a field does not apply to you then, please enter “N/A” for not applicable.
Please be complete, including amounts for social security, pensions, interest on savings, face value of CD's, money markets, ect.
In order for your application to be considered, it 1) must be competed in full 2) be returned with the wait list fee of $500.00. Make checks payable to “Lasata Heights”
I make this application for admission to Lasata Heights of my own free will, with the knowledge that I may change my mind at any time and request a refund of the wait list fee. I certify that the above information is true and complete to the best of my knowledge. I understand that any false statements or willful misrepresentation shall be cause for rejection of my application and may be grounds for dismissal from Lasata Heights, if admitted.
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