Fillable APPLICATION FOR VOLUNTARY ANNEXATION I (We), the undersigned, (City of Hickory)

Fill Online, Printable, Fillable, Blank APPLICATION FOR VOLUNTARY ANNEXATION I (We), the undersigned, (City of Hickory) Form

Use Fill to complete blank online CITY OF HICKORY (NC) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

APPLICATION FOR VOLUNTARY ANNEXATION I (We), the undersigned, (City of Hickory)

On average this form takes 9 minutes to complete

The APPLICATION FOR VOLUNTARY ANNEXATION I (We), the undersigned, (City of Hickory) form is 4 pages long and contains:

  • 0 signatures
  • 25 check-boxes
  • 24 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Hickory

BROWSE CITY OF HICKORY (NC) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
City of Hickory Voluntary Annexation Application
Page 1 of 4
DATE SUBMITTED:_________________
TO THE CITY COUNCIL OF THE CITY OF HICKORY, NORTH CAROLINA:
I (We), the undersigned, do hereby respectfully make application and petition for voluntary
annexation into the municipal limits of the City of Hickory, and have provided an annexation plat
meeting the requirements of the City of Hickory
1. The property be voluntarily annexed is located on _______________________________
__________________________between_________________________and_________________
_______________________ and is shown in more detail on the attached survey.
PIN NO. (S) :____________________________________________________________
Physical (Street) Address: __________________________________________________
2. The property is owned by: (please print) ______________________________________
(Attach a copy of the most recent deed, contract for purchase or other legal interest
demonstrating an interest in the property.)
Owner Information:
Name: ________________________________________________
Address: _______________________________________________________________
Phone Number: __________________________________________________________
3. The petition is submitted by: ________________________________________________
(If the Petition is submitted by someone other than the owner, the attached agent authorization
must be signed, notarized and submitted from the owner(s) authorizing the agent to act on his
behalf.)
Agent Information:
Name: ________________________________________________
Address: _______________________________________________________________
Phone Number: __________________________________________________________
4. If annexation is approved by the Hickory City Council, and if the property(s) is not currently
zoned by the City of Hickory, the applicant would request that the property be placed into a
____________________________________________ zoning district.
CITY OF HICKORY
APPLICATION FOR VOLUNTARY ANNEXATION
City of Hickory Voluntary Annexation Application
Page 2 of 4
5. WATER AND SEWER AVAILABLILTY AND CONNECTIONS
We, the undersigned property owner(s), herby understand and agree we shall be responsible for all
costs associated with providing for extensions and/or connections to the City of Hickory public
utility system (water and sewer). This includes all design, permitting, construction, legal and
applicable City of Hickory Tap Fees. Furthermore, we shall be responsible for obtaining any and all
necessary easements and encroachment agreements needed to provide for such extensions or
connections and provide those to the City of Hickory as appropriate.
The undersigned owner further acknowledges, they shall be responsible for any future utility
extensions required to serve the property due to subdivision of the property.
6. APPLICANT’S AFFIDAVIT
We, the undersigned property owners(s), hereby certify that the information contained herein and
submitted in support of this application is true and correct and the property owner’s list and
associated envelopes were obtained using the most recent Tax Office property information and are
true, correct and complete.
______________________________________ _____________________________________
Printed Name of Property Owner(s) Signature of Property Owner(s)
_______________________________________ _______________________________________
Address of Property Owner(s) Telephone Number of Property Owner(s)
(Please choose the appropriate notary block)
State of North Carolina – County of __________________
I, the undersigned Notary Public of the County and State aforesaid, certify that
_________________________________ personally appeared before me this day and acknowledged the
due execution of this foregoing instrument for the purposes expressed herein. Witness my hand and
Notarial stamp or seal, this _________ day of _____________, 20____.
My Commission Expires: ___________________ _____________________________
Notary Public
State of North Carolina – County of __________________
I, the undersigned Notary Public of the County and State aforesaid, certify that
__________________________________ personally came before me this day an acknowledged the he /
she is the ___________________________ of __________________________________ corporation /
limited liability corporation / general partnership / limited partnership (strike through the inapplicable),
and that by authority duly given and as the act of such entity he /she signed the foregoing instrument in
its mane on its behalf as its act and deed. Witness my hand and Notarial stamp or seal, this
____________ day of _________________, 20_____.
My Commission Expires: ___________________ _____________________________
Notary Public
City of Hickory Voluntary Annexation Application
Page 3 of 4
Annexation Plat Checklist
The survey map of your property is not acceptable as an annexation plat. Therefore, a Professional Land
Surveyor must prepare an annexation plat of the area to be annexed. The surveyor will complete the
checklist below as part of the preparation of the plat. The checklist must be returned with the plat before
the review of the petition will begin.
Annexation know as: _________________________________________________ Date: ___________
To expedite the annexation process, you must submit two (2) copies of an annexation plat that has the
information specified below, and shown on its face.
____ Title (“Satellite Annexation” or “Contiguous Annexation”).
____ Title (known as ________) *Should include the name of the property owner(s).
____ Address (Physical Address if property has one).
____ Parcel Identification Number (PIN).
____ Date of Survey
____ Township.
____ County.
____ Map scale (Both numeric and graphic).
____ Existing City Limits if contiguous shown as bold broken lines as labeled as “Existing City Limits”.
Also list the plat book and page where the existing City Limits may be found. (For assistance,
contact the City Surveyor’s Office at 828.323.7414).
____ New City Limits line(s) shown as bold solid lines and labeled “New City Limit Line”.
____ Bearing and distances for all City Limits lines.
____ Area in Acres.
____ North Arrow.
____ Mayor / City Clerk Certification (see sample plat).
____ Notary Certification for City Clerk.
____ Register of Deeds Certification.
____ Map Review Officer Certification.
City of Hickory Voluntary Annexation Application
Page 4 of 4
____ Grid Tie – If within 2,000 feet of grid monument tie to grid and rotate bearings north to grid north.
If not, tie to intersection of two streets.
____ Type & size of existing property corner markers.
____ Vicinity map.
____ Adjacent owner’s names, Deed Book and Page number for each adjacent owner.
____ Adjacent street names.
____ If petition consists of a satellite annexation, the map must show the area proposed for annexation
with relation to the primary corporate limits of the City of Hickory, (i.e., distance between nearest
line of area being annexed and existing contiguous city limits). When there is question as to
whether the area may be closer to another city than the annexing city, the map shall also show the
area proposed for annexation with relation to the primary corporate limits of the other city.
____ Map must conform to G.S. 47-30 (a) 18” X 24” and 47-30 (b) transparent and archival.
____ Two copies of the transparent and archival map, with all original signatures, must be submitted.
Professional Land Surveyor Information
Name: ______________________________________________________________________________
Address: _____________________________________________________________________________
Telephone Number: ____________________________________________________________________
E-mail: ______________________________________________________________________________
BEARING & DISTANCE
BEARING & DISTANCE
BEARING & DISTANCE
BEARING & DISTANCE
STREET NAME
OWNER
DEED BOOK & PAGE
OWNER
DEED BOOK & PAGE
OWNER
DEED BOOK & PAGE
OWNER
DEED BOOK & PAGE
INDICATE SIZE & TYPE
OF EXISTING PROPERTY
CORNERS
NEW CITY LIMITS LINE
(SHOW NEW CITY LIMITS LINE WITH
BOLD SOLID LINES & DELINEATE WITH THE
WORDS NEW CITY LIMITS LINE.)
(SHOW EXISTING CITY LIMITS LINES AS BOLD
BROKEN LINES & DELINEATE WITH THE WORDS
EXISTING CITY LIMITS LINE SEE
PLAT BOOK & PAGE)
EXISTING CITY LIMITS LINE
PLATBOOK & PAGE
AREA OF TRACT BEING ANNEXED
NOTES:
THIS IS A SAMPLE MAP AND IS INTENDED ONLY TO DELINEATE DATA
REQUIRED BY THE CITY OF HICKORY ON ANNEXATION MAPS.
GRID TIE IF WITHIN 2000' OF HORIZONTAL CONTROL. IF NO HORIZONTAL
CONTOL, DISTANCE TO NEAREST INTERSECTION WILL SUFFICE.
PLAT NEEDS TO BE SUITABLE FOR RECORDING.
USE EITHER SATELLITE OR CONTIGUOUS TO DESCRIBE THE TYPE OF
ANNEXATION.
IF SATELLITE, THE ANNEXATION MUST SHOW BEARING AND DISTANCE TO
CLOSEST CONTIGUOUS CITY LIMITS.
THE SURVEYOR CAN USE TITLE BLOCK OF PREFERENCE BUT IT MUST
CONTAIN INFORMATION SHOWN IN THE EXAMPLE TITLE BLOCK.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

APPLICATION FOR VOLUNTARY ANNEXATION I (We), the undersigned, (City of Hickory)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 17 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document