Office of
Planning and Zoning
Accessory Dwelling Unit Affidavit
Office of Planning & Zoning Revised 2017/11
Accessory Dwelling Unit Affidavit Page 1 of 2
ADU#
SFDU Address Screen #
ADU Address Screen #
Alternate Key #
On this day, personally appeared before me, the undersigned authority duly authorized to administer
oaths and take acknowledgments, ________________________________________________, whose
address for purposes of this Affidavit is __________________________________________________,
who after being me first duly sworn, upon oath deposes and agrees, in accordance with section 10.01.03,
Lake County Code, Appendix E, Land Development Regulations, the following:
1. The affiant is the owner of the principal structure and will be the owner of the accessory dwelling
unit located on the real property described in Exhibit “A” (the “Property”), attached and
incorporated by reference.
2. Both the principal structure and the accessory dwelling unit located on the Property will remain in
the same ownership for as long as the accessory dwelling unit remains on the Property.
3. The owner of the Property will occupy either the principal dwelling unit or the accessory dwelling
unit for as long as the accessory dwelling unit remains on the Property.
By recording of this document in the public records of Lake County, Florida, it is the intent of the affiant
that this restriction will run with the Property and hereby restrict all of the affiant’s successors and assigns.
If you have any question or concerns please contact our office at 352-343-9641.
__________________________________ ____________________________________
Property Owner’s Name Property Owner’s Name
__________________________________ ____________________________________
Property Owner’s Signature Property Owner’s Signature
The foregoing instrument was acknowledged before this ________ day of _____________, 20_____, by
________________________________________, who is personally known to me or who has produced
________________________________________, as identification and who did _____ or did not _____
take an oath.
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
