Fillable Land Bank `Sandusky County P URCHASER QUALIFICATION FORM

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Land Bank `Sandusky County P URCHASER QUALIFICATION FORM

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LRC-811 Page 1 of 2
Dated: 09/28/20
`Sandusky County
Land Bank
2511 Countryside Drive, Suite C
Fremont, OH 43420
419.334.6252
landbank@co.Sandusky.oh.us
P
URCHASER QUALIFICATION FORM
FOR-PROFIT ORGANIZATION
T
he Sandusky County Land Reutilization Corporation (Land Bank) has established
requirements for those individuals, community groups, non-profit or for-profit organizations
or business entities wishing to acquire property from the Land Bank. Each potential
purchaser must complete the following information prior to submitting a request for a
specific property.
Name of Business
Primary Contact
Address
Phone Number
City
State
Zip Code
E-Mail
Description of business:
List all properties currently owned in Sandusky County. Use additional sheet if necessary.
Parcel
Number
Are property
taxes paid in
full?
Any
outstanding
code
violations?
List current use
of property
Has this business owned property that has been foreclosed upon for delinquent taxes?
☐ Yes ☐ No If yes, please provide parcel number(s) and year of foreclosure.
Has this business owned property that has been the subject of a mortgage foreclosure?
☐ Yes ☐ No If yes, please provide parcel number(s) and year of foreclosure.
Purchase Qualification Form For-Profit Organization
LRC-811 Page 2 of 2
Dated: 09/28/20
What types of property is your organization interested in acquiring from the Land Bank?
Please mark any applicable property type.
Property Type Residential Commercial
Vacant lot(s)
Structure(s) in need of rehabilitation
Structure(s) ready for occupancy
I affirm that all information provided above is accurate. I understand that all information is
subject to verification and that any information found to be false will result in the
disqualification of this organization to acquire Land Bank property during the next 12
months.
Signature
Date
Land Bank Use Only
☐ Organization meets requirements established to acquire property from Land Bank
☐ Organization is ineligible to purchase Land Bank properties
☐ Delinquent Taxes
☐ Property Code Violations
☐ Tax Foreclosure Status
☐ Mortgage Foreclosure
☐ Falsification of Information
☐ Other:
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Land Bank Sandusky County P URCHASER QUALIFICATION FORM

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Completed 9 April 2021

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