The Cottages at Manchester Manor

3200 Kensington Court, Manchester, MD 21102
410-239-1154

Application for Independent Retirement Living
(Page 1 - We will mail you pages 2-3 & the Priority Position Agreement)

Primary applicant: ________________________________________
Address: _______________________________________________
City: __________________ State: ______________ Zip: _________
Telephone: __________________ Date of Birth: ________________
If this application is for two people to live in the same cottage unit, please provide the following information for the second applicant:
Name: _________________________________________________
Address (if different than above):______________________________
City: __________________ State: ______________ Zip: _________
Telephone: __________________ Date of Birth: _________________
Relationship: ____________________________________________
Type of Unit Preferred: (Unless you have specific preferences, it is best to select "any" then you will have the opportunity of considering any cottage that becomes available regardless of its features.)

Any,Duplex A or B, Coach (End Unit) A, Coach (Interior Unit)B, Basement Cottage
________________________________________________

It is understood that completion and submission of this application does not guarantee occupancy. A confidential financial data form and personal interview is also required as part of the application process. Prior to occupancy, each applicant will also be required to provide a physician's statement. A non-refundable $50.00 processing fee payable to Manchester Manor Limited Partnership must accompany this application.

Signature of Primary Applicant ________________________________
Signature of Second Applicant ________________________________
Date __________________
Manchester Manor LTD. Partnership
Bill Braun, Residential Director_________________________

We Cordially Invite You To Check Us Out!

	Manchester Manor	Home "A"	Home "B"
FEATURES:
Bedrooms	2 (All Units)	______	______
Garage (12.5' x 22')	1 Car	______	______
Sprinkler Systems	All Units	______	______
Heat System	Gas	______	______
Central A/C	Yes	______	______
Exterior	Brick	______	______
Concrete Slabs	No!	______	______
Crawl Spaces	Yes!	______	______
Public Water & Sewer	Yes	______	______
Campus Size	7.5 Ac.	______	______
Total # Cottages	34	______	______
Cottage Size:
Duplex Home =	1,060 sf	______	______
Coach Home =	988 sf	______	______
Energy Package:
HVAC =	13+ SEER	______	______
Gas Furnace =	90+% Eff.	______	______
Wall Insulation =	R-13	______	______
Ceiling Insulation =	R-30	______	______
Windows (Tilt)	Anderson	______	______
Appliances (Whirlpool):
Stove/Oven	Self-Clean	______	______
Refrigerator	Ice Maker	______	______
Washer/Dryer	Yes	______	______
Dishwasher	Yes	______	______
Garbage Disposal	Yes	______	______
Exhaust Fan	Yes	______	______
Microwave/Fan/Lt.	Optional	______	______
Decks	Yes	______	______
Sun Rooms	Select Few	______	______
Cathedral Ceilings	Select Few	______	______
NEIGHBORHOOD:
Shopping	Yes	______	______
Churches	Yes	______	______
Medical/Dental	Yes	______	______
Parks	Yes	______	______
COMMUNITY FEE (inc.):	$238/ Mo.	______	______
Water & Sewer Charges	Yes	______	______
Exterior & Interior Maint.	Yes	______	______
Grounds Maint./Mowing	Yes	______	______
Snow Removal	Yes	______	______
Appliances	Yes	______	______
Furnace/AC - Maint. & Repair	Yes	______	______
Fire & Liability Insurance	Yes	______	______
Kensington Room	Yes	______	______
Outside Lighting	Yes	______	______
Trash Pick-up	Yes	______	______
Medical Alert System	Yes	______	______