Assessment and Reserve Funding Disclosure Worksheet

Please complete this worksheet after adopting a reserve funding plan for the year stated in #2 below. Per California Civil Code Section 5560, a reserve funding plan must be adopted by the board of directors at an open meeting before the membership.

Your Name (required)

Your Email (required)

1) Association name

2) Calendar/fiscal year the disclosure form is for:

Month

Day

Year

THROUGH

Month

Day

Year

3) Adopted budgeted total monthly assessment/"dues" (from all homeowners)

4) Portion of monthly total assessment/"dues" from #3 above transferred to reserves:

5) Special assessments that have been approved by the board and/or members:

DATE ASSESSMENT WILL BE DUE	DATE DUE	DESCRIPTION	AMOUNT PER UNIT (AVERAGE) in $

6) Submitted by

Phone

Date

Please note: Once submitted, the Assessment and Reserve Funding Disclosure Form (ARFDS) will be sent to you within 1-2 days and it should be
distributed with your budget package. The Reserve Study that this worksheet is based on will be
deemed final upon receipt of the completed worksheet. Any subsequent adjustments to the Reserve
Study will constitute a revision, necessitate a revised disclosure form, and be subject to a fee.

Assessment and Reserve Funding Disclosure Worksheet

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