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DECLARATIONOFOWNERSHIP

AllOwnersofRecordMustFileAnAffidavit

, being duly sworn upon his/her oath, deposes and

statesthat

(Nameofownersigningaffidavit;ifacorporationor business,nameofindividualsigningaffidavitandlegalcapacityin

saidcorpor ationorbusiness)

is/arethelegalowner(s)/authorizedofficialofthelegalowner(s)ofthesubjectproperty.

(OwnerSignature)

STATEOF )

COUNTYOF )

Subscribedandsworntobeforemethis dayof ,20 .

NotaryPubli c: MyAppointmentExpires:

AUTHORIZATIONOFCONTRACTPURCHASER

, being duly sworn upon his/her oath, deposes and

statesthat

(Nameofcontractpurchasersigningaffidavit;ifacorporationorbusiness,nameofi ndividualsigningaffidavitandlegal

capacity insaidcorporationorbusi ness)

istheholderofacontractt opurchasethesubjectpropertyfromtheowner(s)andisthereforeauthorizedtofile

thisapplicationontheowner(s)behalf.

(PurchaserSignature)

STATEOF )

COUNTYOF )

Subscribedandsworntobeforemethis dayof ,20 .

NotaryPubli c: MyAppointmentExpires:

AUTHORIZATIONOFAGENCY

FillInIfApplicantIsAnAgentForLandownerOrContractPurchaser

I,

(Nameofpersonsigningaff idavit;ifa corporationorbusiness,nameofindividualsigningaffidavi tandlegalcapaci tyinsaid

corporationorbusiness)

having filedProof of  Ownership Affidavit asthe Legal Owner(s)orContractPurchaserofthepropertydeclare

thatIhaveauthorized to file this application

onmybehalf. (NameofAgent)

(AgentSi gnat ure)

STATEOF )

COUNTYOF )

Subscribedandsworntobeforemethis dayof ,20 .

NotaryPubli c: MyAppointmentExpires:

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