RELEASE OF PERSONAL PROPERTY

 Name: Client first name Client last name Date: Date

Please let this letter serve as confirmation that the person(s) listed below are authorized to pick up my personal belongings in the event I am discharged from The Nova Residence and unable to personally pick up any remaining personal property.

Name AND Phone Number: Text field

Name AND Phone Number: Text field

Name AND Phone Number: Text field

Upon pick up, aforementioned authorized person will be required to provide a photo ID to verify their identity.

I understand and agree that a $25 move out fee will be required prior to release of my personal belongings in the event The Nova Residence has to pack my belongings or if The Nova Residence must store my belongings for more than 5 days after my departure.  Payment shall be made by money order made payable to The Nova Residence or online at www.paypal.me/novaresidence  prior to or at time of release of property.

Failure to provide payment and pick up personal belongings within 30 days of program discharge will result in all items being donated.

By continuing, you agree that your electronic signature is the legally binding equivalent to your handwritten signature. Whenever you execute an electronic signature, it has the same validity and meaning as your handwritten signature. You will not, at any time in the future, repudiate the meaning of your electronic signature or claim that your electronic signature is not legally binding.

 
Resident Signature  Signature                                                                                                            

Date: Date

VERIFICATION OF RELEASE:  Personal items were released to: __________________________________

Signature - Person Property Released To _________________________________     Date: _____________

Staff Signature ____________________________________                    Date ______________________