Fillable Mobile Home Park Application - Fillable

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Mobile Home Park Application - Fillable

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The Mobile Home Park Application - Fillable form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Town of Fishkill

BROWSE TOWN OF FISHKILL (NY) FORMS

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Page 1 of 4
Facility Name:
Facility Address:
City/Town: State: NY Zip Code:
Total Number of Units:
Owner’s Name:
Owner’s Address:
City/Town: State: Zip Code:
Telephone Number: Fax Number:
E-Mail Address:
Are you a citizen of the United States?
Are you or at any time, have you been a member of any organization listed as subversive by the
Attorney General of the United States?
Have you been convicted of a crime?
• List of all current residents - list must include names and addresses of all current residents.
• Current Health Department Approval for Sewer and Water
Town of Fishkill
Town Clerk’s Office
Application for Mobile Home Park Operation
SECTION B: Owner Information (Entire section must be completed by all applicants.)
SECTION C: (The following documents must be submitted by all applicants as part of this
application.)
FOR OFFICE USE ONLY
Application No.:
Application Fee:
Escrow Deposit
(If applicable):
SECTION A: Facility Information (Entire section must be completed by all applicants.)
Town of Fishkill - 807 Route 52 - Fishkill, NY 12524
Website: www.fishkill-ny.gov
Page 2 of 4
To calculate the Applicable Fees and Escrow Deposit for this application, please refer to the
section of the Town’s Current Fee Schedule for Mobile Home Park Permits and Escrow Funds.
Applicable Fee
Calculation
(Please utilize the Town’s
Current Fee Schedule and
fill in blanks below)
Total
Application for Original License
Up to and including five (5) homes
$
$
Thereafter, per home (no. of homes = )
$
$
Minimum Fee (per site)
$
$
Transfer of License
$
$
Escrow Deposit
$
$
Renewal of Annual Permit
$
$
Town of Fishkill
Town Clerk’s Office
Application for Mobile Home Park Operation
SECTION D: Applicable Fees (Entire section must be completed by all applicants.
All Applicable fees must be submitted with this application.)
Town of Fishkill - 807 Route 52 - Fishkill, NY 12524
Website: www.fishkill-ny.gov
Page 3 of 4
I do solemnly swear that the answers and statements
made by me in this application are true to the best of my knowledge.
Notary Public:
State of , County of , on this day of
20 , before me, the undersigned, a notary public in and for said
state, personally appeared , personally known to me or
proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to
the within instrument and acknowledged to me that he/she executed the same in his/her capacity, and
that by his/her signature on the instrument, the individual, or the person upon behalf of which the
individual acted, executed the instruction.
Signature of Applicant
SECTION E: Affidavit (Entire section must be completed by all applicants.
Notary Public
Town of Fishkill
Town Clerk’s Office
Application for Mobile Home Park Operation
Town of Fishkill - 807 Route 52 - Fishkill, NY 12524
Website: www.fishkill-ny.gov
Page 4 of 4
FOR TOWN CLERK’S OFFICE USE ONLY
Application Referred to the Town Zoning Administrator on day of
20 with memo to perform inspection of said facility and to report findings and
recommendation for issuance of permit to the Town Clerk’s Office.
Inspection and Recommendation Received from the Town Zoning Administrator.
Permit issued by the Town Clerk’s Office on day of 20 .
Permit is valid for one (1) calendar year starting on day of 20 and
ending on day of 20 .
Town of Fishkill
Town Clerk’s Office
Application for Mobile Home Park Operation
Town of Fishkill - 807 Route 52 - Fishkill, NY 12524
Website: www.fishkill-ny.gov
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Mobile Home Park Application - Fillable

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Completed 12 July 2020

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