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LE~IN~T~N CUND~VIINIUM CUNVERSIUN B~lARII CCND~MINIUiVI CDNVERSI4N LICENSE APPLICATION Chapter 144 of the Code of the Town of Lexington To the Lexington Condominium Conversion Board: The following applicant wishes to convert the housing accommodations in the Town of Lexington identified below into condominium or cooperative units, The applicant hereby requests a candominium conversian license for such conversion. Applicant name and address: ^ Dwner ^ Purchaser Address of accommodations to be converted: In accordance with Section 144-4 of the Lexington Code, the applicant attaches evidence of the following to this application: ^ Notif cation to the Lexington Housing Authority of the planned conversion. ^ Notif cation to the Lexington Housing Assistance Board of the planned conversion. ® Notification to all affected tenants of the planned conversion in accordance with Section 4 of Chapter 527 of the Acts of 1983 and evidence of the applicant's compliance with the requirements of Section 4 of Chapter 527 of the Acts of 1983. The applicant has also paid the candominium conversion license .ling fee required under Section 144-9 of the Lexington Code. Signature of Applicant Date BOS 111 11741944.1