DEPARTMENT OF COMMUNITY DEVELOPMENT
APPLICATION FOR LIEN REDUCTION
LIST ALL FOLIO #S: ___________________________
DATE RECEIVED: ___________________________________________________________________
Property Owner: ___________________________________________________________________
Mailing Address: ___________________________________________________________________
Phone Number:__________________________ Fax Number:_____________________________
E-mail Address: ___________________________________________________________________
Applicant: ________________________________________________________________________
Phone Number: ___________________________________________________________________
E-mail Address: ___________________________________________________________________
Is this property in compliance? __Y __N
If yes, what is the compliance date? _______________
Legal Description (provide a complete legal description of the property).
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Describe the current status of the property.
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Briefly describe your proposal(s) for lien reduction.
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DEPARTMENT OF COMMUNITY DEVELOPMENT
If a lien reduction is negotiated, describe the immediate actions that would be taken,
besides securing all require permits, to bring the property into a habitable or functional
conditions.
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Lien Reduction Application Checklist
_____ 1. Property legal description.
_____ 2. Provide the authorized agent affidavit, if required.
_____ 3. Provide information on the current value of the property.
_____ 4. Documentation of expenditures to secure the property (i.e. real estate appraisal,
etc.)
_____ 5. Value of expenditure(s) to improve the property in proportion to the current
value of the property.
_____ 6. Provide any additional information pertinent to the property that is requested by
the Town’s representatives or Special Magistrate.
DEPARTMENT OF COMMUNITY DEVELOPMENT
APPLICANT’S AFFIDAVIT
The Undersigned, first being duly sworn depose that all answers to the questions in this
application, and all supplementary documents made a part of the application are honest
and true to the best of (my)(our) knowledge and belief. (I)(We) understand this application
must be complete and accurate before the application can be submitted and the hearing
advertised.
OWNER OR TENANT AFFIDAVIT
(I)(WE), , being first duly sworn,
depose and say that (I am)(We are) the owner tenant of the property described and
which is the subject matter of the proposed hearing.
Signature Signature
Sworn to and subscribed to before me Notary Public:
This ______day of ___________, ________ Commission Expires:
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CORPORATION AFFIDAVIT
(I)(WE), , being first duly sworn,
depose and say that (I am)(We are) the President Vice-President Secretary Asst.
Secretary of the aforesaid corporation, and as such, have been authorized by the
corporation to file this application for public hearing; and that said corporation is the
owner tenant of the property described herein and which is the subject matter of the
proposed hearing.
Attest:
Authorized Signature
Office Held
(Corp. Seal)
Sworn to and subscribed to before me Notary Public:
This day of ________, _________ Commission Expires:
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DEPARTMENT OF COMMUNITY DEVELOPMENT
PARTNERSHIP AFFIDAVIT
(I)(WE), , being first duly sworn, depose and
say that (I am )(We are) partners of the hereinafter named partnership, and as such, have
been authorized to file this application for a public hearing; and that said partnership is the
owner tenant of the property described herein which is the subject matter of the proposed
hearing.
(Name of Partnership)
By % By
By % By
Sworn to and subscribed to before me Notary Public:
This _______ day of _________, _________ Commission Expires:
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ATTORNEY AFFIDAVIT
I, , being first duly sworn, depose and say that I am a
State of Florida Attorney at Law, and I am the Attorney for the Owner of the property
described and which is the subject matter of the proposed hearing.
Signature
Sworn to and subscribed to before me Notary Public:
This _______ day of ___________, ________ Commission Expires:
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DEPARTMENT OF COMMUNITY DEVELOPMENT
DISCLOSURE OF INTEREST
If the property, which is the subject of the Application, is owned or leased by a CORPORATION, list the
Principal Stockholders and the percentage of stock owned by each. NOTE: Where the Principal Officers or
Stockholders consist of another Corporation(s), Trustee(s), Partnership(s) or other similar entities, further
disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the
ultimate ownership interest in the aforementioned entity.
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Corporation Name
Name, Address and Office Percentage of stock
_________________________________________ __________________________________
_________________________________________ __________________________________
_________________________________________ __________________________________
If the property, which is the subject of the Application, is owned or leased by a TRUSTEE, list the Principal
Stockholders and the percentage of stock owned by each. NOTE: Where the Principal Officers or
Stockholders consist of another Corporation(s), Trustee(s), Partnership(s) or other similar entities, further
disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the
ultimate ownership interest in the aforementioned entity.
_________________________________________________
Trust Name
Name, Address and Office Percentage of stock
_________________________________________ __________________________________
_________________________________________ __________________________________
_________________________________________ __________________________________
If the property, which is the subject of the Application, is owned or leased by a PARTNERSHIP or LIMITED
PARTNERSHIP, list the Principal Stockholders and the percentage of stock owned by each. NOTE: Where the
Principal Officers or Stockholders consist of another Corporation(s), Trustee(s), Partnership(s) or other similar
entities, further disclosure shall be required which discloses the identity of the individual(s) (natural persons)
having the ultimate ownership interest in the aforementioned entity.
_________________________________________________
Partnership or Limited Partnership Name
Name, Address and Office Percentage of stock
_________________________________________ __________________________________
_________________________________________ __________________________________
_________________________________________ __________________________________
DEPARTMENT OF COMMUNITY DEVELOPMENT
COST RECOVERY AFFIDAVIT
I hereby acknowledge and consent to the payment of all applicable fees involved as part of
my application process. These fees include but are not limited to: application fees, postage,
advertising, and attorney fees regardless of the outcome of the to “Special Master’s Final
Judgment”.
Please type or print the following:
Date: _________________________ Public Hearing No. ___________________
Full Name:
ٱ Mr. ٱ Mrs. ٱ Ms. _____________________________________________________________
Current Address: ____________________________________ City: ______________________
State: _______________Zip: _________ Telephone Number (______) _____________________
Date of Birth: ____________________
___________________________________________
Signature
SWORN AND SUBSCRIBED BEFORE ME THIS ________DAY OF_______________20_____
________________________________________________
Notary Public, State of Florida at Large
My Commission expires_____________________20_____
Pursuant to Article III, Sec. 3-30(I) of the Town Land Development Regulations (formerly
Ordinance No. 06-07 -Cost Recovery of the Town of Cutler Bay, Florida)
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