SOUTHERN WALK AT BROADLANDS HOMEOWNERS ASSOCIATION, INC.

Instrument for Consent to Amendment of
Declaration of Covenants, Conditions, and Restrictions

I am the owner of

within the Southern Walk at Broadlands subdivision, and by signing this Instrument below, I/we hereby certify that I/we consent to, agree to, approve, and ratify the amendment of the Declaration of Covenants, Conditions, and Restrictions for Southern Walk at Broadlands, originally recorded in the Clerk’s Office of the Circuit Court of Loudoun County, Virginia, in Deed Book 2151, at Page 0347 (the “Declaration”) as provided in the Addendum Regarding Proposed Declaration Amendments to allow for the Board to enter an HOA Contract with a Telecommunications Provider for Telecommunications Services at bulk rates.

Notes: This consent and approval will remain valid so long as the above-signed Owner(s) own(s) the Lot. If the Lot is transferred to any person who has not hereby consented, or if written notice is received from the Owner(s) that they wish to revoke their consent, this consent shall be revoked. Upon recordation of the instrument amending the Declaration this consent shall become irrevocable.

If more than one person owns a Lot, please submit additional copies of this Instrument & Appointment containing the additional owner signatures.

If you have any questions please contact the Association’s manager, Laura Marshall, at [email protected] or 703-385-1133.

PLEASE RETURN THIS FORM TO ASSOCIATION MANAGEMENT AT YOUR EARLIEST CONVENIENCE.

Signed Date: