COST RECOVERY AFFIDAVIT
I hereby acknowledge and consent to the payment of all applicable fees incurred as part of
my application process. These fees include, but are not limited to, application fees, postage,
advertising, town attorney fees, planning consultant fees, and any other costs incurred by
the Town of Cutler Bay for the review of this community development application regardless
of the outcome of the application and public hearing process, pursuant to Section 3-30(9) of
the Town of Cutler Bay Land Development Regulations. Further, I understand and
acknowledge that failure to remit payment for incurred costs constitutes a violation of the
Town’s Land Development Regulations and fines may be levied to secure compliance.
Date: ________________
Applicant Name: __________________________________________________________________________
Applicant Mailing Address: ________________________________________________________________
________________________________________________________________
Applicant E-mail Address: ________________________________________________________________
Applicant Telephone Number: ____________________________________________________________
Affidavit: To be executed by the owner.
If ownership is a corporation, Articles of Incorporation (full document filed with the Secretary of State) and a Board
Resolution authorizing an individual or agent to sign on its behalf must be included. If ownership is an LLC (or
similar), Articles of Organization (full document filed with the Secretary of State) and legal documentation
authorizing an individual or agent to sign on its behalf must be included.
State of ____________________________
County of __________________________
____________________________________ being first duly sworn, deposes and says that: They are
the □ Owner □ Partner □ Officer □ Agent of _____________________
and that they, in the capacity indicated above, are authorized to approve cost recovery for
the purpose of this application with the Town of Cutler Bay.
Sworn and subscribed before me this ________ day of _______________________, 20_______.
____________________________________
Affiant Signature
____________________________________ _______________________________________
Print Name and Title Notary Public, State of Florida
My Commission Expires: ______________
