Less Than Fee Application

2. CONTACT INFORMATION

   Please provide your contact information below.

   Please provide your contact information below.

4. First Name*

5. Last Name*

7. Phone*

9. Email*

11. Preferred Method of Contact*

    Please choose at least one method. Check all that apply.

    1. Daytime phone
    2. Daytime email
    3. Evening phone
    4. Evening email

13. MAILING ADDRESS

15. Address1*

17. Address2

19. City*

20. State*

21. Zip*

23. LAND DESCRIPTION

    Please provide information regarding your home and adjacent vacant lot.

    Please provide information regarding your home and adjacent vacant lot.

25. Home Address

    Please provide the address of the residential home adjacent to the vacant lot property.

    Please provide the address of the residential home adjacent to the vacant lot property.

27. Address1*

29. Address2

31. City*

32. State*

33. Zip*

35. Vacant Lot Address

    Please provide the address of the vacant lot adjacent to the residential home entered above.

    Please provide the address of the vacant lot adjacent to the residential home entered above.

37. Address1*

39. Address2

41. City*

42. State*

43. Zip*

45. 1. Are you the sole owner of the vacant lot?*

    Select only one.

    1. Yes
    2. No
47. 2. If you answered no to the above question, please list all owners of record.

49. 3. Do you currently own development rights to the vacant lot?*

    Select only one.

    1. Yes
    2. No
    3. I don't know.
51. 4. Have you sold or attempted to sell any development rights on your vacant lot?*

    Select only one.

    1. Yes
    2. No
53. 5. Are there any agreements that affect any development rights of your vacant lot?*

    Select only one.

    1. Yes
    2. No
55. 6. Do you believe your development rights of your vacant lot should be valued less than $100,000?*

    Select only one.

    1. Yes, the development rights should be valued less than $100,000.
    2. No, the development rights should be valued equal to or greater than $100,000.
    3. I don't know.
57. 7. How do you currently use your vacant lot?*

    Please check all that apply.

    1. I do not use the vacant lot.
    2. Shed
    3. Garage
    4. Pool
    5. Trailer storage
    6. Other storage
    7. Non-independent residential structure
    8. Guest House
    9. Allowed Expansion of Adjacent House
    10. Other
59. 9. If you selected other in the previous question, please explain the use.

61. 10. Do you have any outstanding code violations on the vacant lot?*

    Select only one.

    1. Yes
    2. No
63. 11. Do you have any open permits on the vacant lot?*

    Select only one.

    1. Yes
    2. No

65. 12. Is your home or the adjacent vacant lot subject to any leases, mortgages, liens or other encumbrances?

    Please check all that apply.

    Please check all that apply.

67. Home*

    1. None
    2. Lease
    3. Mortgage
    4. Lien
    5. Other Encumbrance

68. Adjacent Vacant Lot*

    1. None
    2. Lease
    3. Mortgage
    4. Lien
    5. Other Encumbrance

70. 13. If you checked anything other than "None" for your home or adjacent vacant lot in question No. 12, how many other parties are involved? And please provide those party(s) name, address, email address, phone number and significance.

    1. 1
    2. 2
    3. 3

72. A. Party and Significance. Example: National Bank - Mortgage to the Home*

74. First Name*

75. Last Name*

77. Address1*

79. Address2

81. City*

82. State*

83. Zip*

85. Phone*

86. Email Address*

88. B. Party and Significance. Example: National Bank - Mortgage to the Home*

90. First Name*

91. Last Name*

93. Address1*

95. Address2

97. City*

98. State*

99. Zip*

101. Phone*

102. Email Address*

104. C. Party and Significance. Example: National Bank - Mortgage to the Home*

106. First Name*

107. Last Name*

109. Address1*

111. Address2

113. City*

114. State*

115. Zip*

117. Phone*

118. Email Address*

120. 14. Did you obtain consent from any party mentioned in the above question?*

     Select only one.

     1. Yes, I obtained consent from all parties.
     2. I obtained consent from some parties.
     3. No, I did not obtain consent from any party.
     4. I don't know if I need consent from any party.

122. REPRESENTATIVE INFORMATION

124. 15. Do you have an attorney, Realtor or agent representing you in this matter?*

     Select only one.

     1. Yes
     2. No
126. 16. If you answered yes to question No 15, how many representatives do you have and please provide the representative(s) contact information.

     1. 1
     2. 2

128. A. Representative's Relationship: Attorney, Realtor or Agent?*

130. First Name*

131. Last Name*

133. Address1*

135. Address2

137. City*

138. State*

139. Zip*

141. Phone*

142. Email Address*

144. B. Representative's Relationship: Attorney, Realtor or Agent?*

146. First Name*

147. Last Name*

149. Address1*

151. Address2

153. City*

154. State*

155. Zip*

157. Phone*

158. Email Address*

160. 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:


162. 1. Receive an email copy of this form.
163. Email address

     This field is not part of the form submission.

164. Submit Submit and Print

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