2. CONTACT INFORMATION
   Please provide your contact information below.
4. First Name*
5. Last Name*
7. Phone*
9. Email*
11. MAILING ADDRESS
13. Address*
15. Address
17. City*
18. State*
19. Zip*
21. Primary Lot Address

    Please provide the address of the Primary Lot (residential home).  Please provide the Parcel ID Number (RE #) if you have that information.

23. Primary Lot Address*
25. Primary Lot Address
26. Primary Lot Parcel ID Number (RE #)
28. City*
29. State*
30. Zip*
32. Secondary Lot Address

    The Secondary Lot is the lot from which you propose to sell the residential development right that is adjacent to the lot with your home. Please provide as much information you have regarding the street address, legal description and Parcel ID Number (RE #) of the Secondary Lot adjacent to the residential home entered above.  If you propose to include additional Secondary Lots, please provide that information in question No. 10 at the end of this form.

34. Secondary Lot Address
36. Secondary Lot Legal Description
38. Secondary Lot Parcel ID Number (RE #)
40. 1. Are you the sole owner of the Secondary Lot?*

    Select only one.

    1. Yes
    2. No
42. 2. If you answered no to the above question, please list all owners of record.
44. 3. Have you sold the development rights or entered into any agreements regarding the development rights for the Secondary Lot?*

    1. Yes
    2. No
46. 4. If you answered yes to the above question, please explain.
48. 5. Are you aware of any outstanding code violations on the Secondary Lot?*

    Select only one.

    1. Yes
    2. No
50. 6. Are you aware of any open permits on the Secondary Lot?*

    Select only one.

    1. Yes
    2. No
52. 7. To your knowledge, is your home or the Secondary Lot subject to any leases, mortgages, liens or other encumbrances?

    Please check all that apply.

54. Home*

    1. None
    2. Lease
    3. Mortgage
    4. Lien
    5. Other Encumbrance
55. Adjacent Vacant Lot*

    1. None
    2. Lease
    3. Mortgage
    4. Lien
    5. Other Encumbrance
57. 8. If you checked anything other than "None" for your home or Secondary Lot in question No. 7, please provide each party's name, address, email address, phone and the type of encumbrance.
59. A. Party and the Type of Encumbrance. Example: National Bank - Mortgage to the Home
61. First Name
62. Last Name
64. Address1
66. Address2
68. City
69. State
70. Zip
72. Phone
73. Email Address
75. B. Party and the Type of Encumbrance. Example: National Bank - Mortgage to the Home
77. First Name
78. Last Name
80. Address1
82. Address2
84. City
85. State
86. Zip
88. Phone
89. Email Address
91. 9. If you choose to have an attorney, realtor or agent representing you in this matter, please provide their name and contact information.
93. A. Type of Representative: Attorney, Realtor or Agent?
95. First Name
96. Last Name
98. Address1
100. Address2
102. City
103. State
104. Zip
106. Phone
107. Email Address
109. B. Type of Representative: Attorney, Realtor or Agent?
111. First Name
112. Last Name
114. Address1
116. Address2
118. City
119. State
120. Zip
122. Phone
123. Email Address
125. 10. Do you have any other information you would like to share?

     Please use this space to indicate if you are proposing more than one Secondary Lot, and include the address, legal description and Parcel ID Number (RE #) for additional Secondary Lots.

127. ACKNOWLEDGEMENT*

     I ACKNOWLEDGE the County's offer price for the residential building right on the Secondary Lot will be the Monroe County Property Appraiser's Market Land Value (MLV), up to $99,999, that is in effect at the time I enter into a purchase agreement with the County.  

     1. I acknowledge
129. ACCEPTANCE DECLARATION*

     I CERTIFY that the statements on this form are true and correct to the best of my knowledge and belief. I understand that if I withhold, misrepresent or falsify information on this form, I am subject to the penalties for inaccurate or false statements and/or denial or revocation of this application and any participation in this program.

     1. I agree
Leave This Blank:


131. 1. Receive an email copy of this form.
132. Email address

     This field is not part of the form submission.

133. Submit Submit and Print

* indicates a required field