C:\Documents and Settings\CherylW\My Do
cuments\New Website\Application Forms\Petition To
Annex Application.doc 2-25-2016
A legal description and a copy of the
assessor’s map of the property must be
submitted with this petition.
CITY OF HAPPY VALLEY
16000 SE Misty Drive
Happy Valley, OR 97086
Phone: 503-783-3800 Fax: 503-658-5174
PETITION TO ANNEX
To the City Council of the
City of Happy Valley, Oregon
I (we), the undersigned owner(s) of the property described below and/or elector(s)
residing at the location below described, hereby petition and give consent to, annexation
of said property to the City of Happy Valley.
The consent for annexation is for the following described property:
__________________________________________________________________
Street Address of Property (if address has been assigned)
__________________________________________________________________
Legal Description (Subdivision Name, Lot number(s))
__________________________________________________________________
Tax Map and Tax Lot Number
SIGNATURE(S) OF LEGAL OWNER(S) AND/OR REGISTERED VOTER(S)
____________________________ ___________ __________ __________________
Signature Owner Initial Voter Initial Date
____________________________ ___________ __________ __________________
Signature Owner Initial Voter Initial Date
____________________________ ___________ __________ __________________
Other Authorized Signature Owner Initial Voter Initial Date
_______________________ __________________
_________________________
Street Address
Home Phone Work Phone
____________________________________
Mailing Address
______________________________________
City, State and Zip Code
We, the owner(s) of the property described above and/or elector(s) residing on said property understand the annexation
process can take more than a year. Therefore, we agree to waive the one-year time limitation on this consent established
by ORS 222.173, and further agree that this contract shall be effective
___ Indefinitely, or until ______________.
______________________________________ __________________________________
Signature Date Signature Date
The Population Research Center at Portland State University compiles population estimates which they report to the State of
Oregon on an annual basis. The State of Oregon then uses these estimates to determine the City’s Fair Share of state
funds. Please help us with this effort by indicating below the number of housing units on the above indicated tax lots and the
number of people residing in these housing units. THANK YOU!
Number of housing unit on above lot: _______
Types of housing units: __ Single family ____Multi-family ___ Mobile home or trailer
Number of people occupying these units: __________
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