In accordance with Part XIV, Section 2 (c) of Senate Bill 92, please provide the
following information:

Owner's Name:                 __________________________________________________________

Owner's Mailing Address:      __________________________________________________________

                              __________________________________________________________

                              __________________________________________________________

Rental Property Location:     __________________________________________________________

                              Beech Mountain, NC 28604

By listing this property, you are indicating that it is AVAILABLE for rent. Please
indicate how the property may be rented.

Check one:

_____ Short-term (daily, weekly, etc.)

_____ Long-term (rented or leased for 90 or more consecutive days to the same person)

_____ NOT available for rent this listing period

This is to certify that the information provided above, to the best of my knowledge and
belief, is true and provided in good faith.


_______________________________________________________         __________________________
Signature                                                       Date