APPLICATION -- REVOCABLE LICENSE

Control Number: ______________________

(HOA Use)
Date: _____________________________

Engineering Advisor/-Committee
Wynn Wood Homeowners Association
P.O. Box 488
Camden-Wyoming, DE 19934

Dear Engineering Advisor / Committee Members:

Please accept this as my Application for a Revocable License and request for approval to the following
changes/alterations/additions (“Alteration”) to my residence located at (physical address)

_________________________________________________________________________________ as legally described in

Tax Parcel number: ___________________________________________________________________________________.

Described below is the Alteration that I propose to make, and I am attaching pictures, brochures or other
descriptive material that will accurately describe the design of and material to be used in my Alteration. If
applicable, enclosed are site plans and/or drawings, including lot survey or plot plan showing topography and
ground elevation. I understand that I may not begin the below described work until my receipt of an executed
Revocable License from you, and that I must obtain all applicable governmental permits and licenses upon
approval of the Revocable License. I have obtained approval as needed from my affected neighbors as manifested
by their signatures below.

Description of Alteration: ___________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Signature: ____________________________________

Print Name: ____________________________________

Mailing Address: ____________________________________

Camden-Wyoming, DE 19934

AFFECTED NEIGHBOR(s) APPROVAL (as required):

Signature Print Name Address

Signature Print Name Address

RL Form: 102508
 REVOCABLE LICENSE
Control Number: ______________________
(HOA Use)
Wynn Wood Homeowners Association hereby grants to

__________________________________________________________________________________ his/her heirs, assigns,

and successive owners ("Owners") of the residence located at (physical address)

_________________________________________________________________________________ as legally described in

Tax Parcel number: ______________________________________________________________ in the Town of Camden,

Kent County, Delaware, a Revocable License to perform the following work and effect the following
changes/alterations/additions (“Alteration”) to the exterior of the above described residence:

It is understood that the Owner of said residence is wholly responsible for the maintenance and repair of the above described exterior Alteration.
The Owner shall also assume any and all responsibility for damage to the common or limited common elements or rolling curb specific to that lot
caused by the above described Alteration. Should the Owner fail to maintain the Alteration in a manner acceptable to the Board Officers of the
Association, or should the installation or presence of said Alteration damage or otherwise interfere with common or limited common elements of
the Association or rolling curb specific to that lot, then, upon thirty (30) days written notice from the Association to the Owner setting forth such
damage or failure to maintain, this License shall be revoked without notice to the Owner and the Alteration shall be removed by the Owner within
ten (10) days thereafter, at the Owner's expense. If the Owner fails to remove the Alteration within the required ten (10) days or make repairs to
any damage, then the Association shall have the right to remove the Alteration and charge the Owner for “ALL” expenses incurred in the
removal or repair of any damages.

All terms and conditions of the Association's Declaration, By-laws, rules and regulations pertaining to exterior
alterations and maintenance shall remain in full force and effect, and shall be strictly followed by the Owner.

Dated this ___________ day of _______________________, 20______.

ASSOCIATION: AGREED AND ACCEPTED BY OWNER:

(Signature) (Signature)

(Print name and title) (Print Name)

STATE OF DELAWARE,
COUNTY OF KENT:

Before me, the undersigned authority, on this day appeared _________________________________________ [name of owner],
known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that he/she
executed the instrument for the purposes and consideration expressed in the instrument.

Given under my Hand and Seal of office this __________ day of __________________, 20______.

___________________________________________
Notary Public in and for the State of Delaware

Notary Public Printed Name:

My Commission Expires:

Return to: Wynn Wood Homeowners Association

P.O. Box 488, Camden, DE 19934 RL Form: 102508
(Control Number Format “102508-1” i.e.: Date issued, - Number issued that date)