California Consumer Privacy Act (CCPA)

I want to: I want to: Access My Data Delete My Data Request to Not Sell/Share Correct My Data Limit Use and Disclosure of My Personal Information

Are you requesting your own data? Are you requesting your own data? Yes No

Authorizer Name Authorizer Name

Email Address

Relationship to the Data Subject

Select Brand Select Brand *The Pinnacles at BurtonCalson Management, LLCJack Napier Properties, LLCAssisted Living

Relationship to Organization Relationship to Organization *CustomerEmployeeFormer EmployeeJob ApplicantGeneral Request

First Name

Last Name

Email

Phone

Please provide details to help us facilitate your request

Authorization and Acknowledgement Authorization and Acknowledgement I understand that the organization may confirm my email address before this request can be processed. I understand that I may need to provide further information to process this request. I certify that the information provided in this form is true and accurate to the best of my knowledge.