Voluntary Move Waiver I __________________________________ seek the City of Santa Cruz’s assistance in voluntarily moving from the Gateway/Ross Camp to the Benchlands Camp. I received a City voucher to secure my spot at the Benchlands on April 22nd or April 23rd , 2019. I now freely choose to continue with my relocation to the Benchlands. I have not been removed (forcibly or otherwise) from Ross Camp, nor has my property been seized, destroyed, or damaged. I do / do not seek the City’s assistance to move my property (consisting of _____ assigned totes) to the Benchlands. (Please circle one, and fill in the number of totes.) ________I have mobility challenges, and I therefore seek the City’s assistance in transporting me to the Benchlands. (Please initial, if applicable.) I declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct ___________________________________ Printed Name ______________________________________ ______________________ Signature Date Voluntary Move Waiver I __________________________________ seek the City of Santa Cruz’s assistance in voluntarily moving from the Gateway/Ross Camp to the Benchlands Camp. I received a City voucher to secure my spot at the Benchlands on April 22nd or April 23rd , 2019. I now freely choose to continue with my relocation to the Benchlands. I have not been removed (forcibly or otherwise) from Ross Camp, nor has my property been seized, destroyed, or damaged. I do / do not seek the City’s assistance to move my property (consisting of _____ assigned totes) to the Benchlands. (Please circle one, and fill in the number of totes.) ________I have mobility challenges, and I therefore seek the City’s assistance in transporting me to the Benchlands. (Please initial, if applicable.) I declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct. ___________________________________ Printed Name ______________________________________ Signature ______________________ Date