Fillable REGISTERED ABANDONED AND VACANT BUILDING REMOVAL FORM (Fulton County Government)

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REGISTERED ABANDONED AND VACANT BUILDING REMOVAL FORM (Fulton County Government)

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REGISTERED ABANDONED AND VACANT
BUILDING REMOVAL FORM
Department of Fulton County Police
4701 Fulton Industrial Boulevard,
Atlanta, Georgia 30336
404-613-5700
In order to remove a property that has been registered under Fulton County's Abandoned and
Vacant Buildings ordinance please complete the attached form. This form must be notarized. If the
person completing this form is not the owner of the property as listed in Fulton County tax records,
documentation of authorization is required. Return or mail the form to: Fulton County Police
Department, 4701 Fulton Industrial Boulevard, Atlanta, Ga. 30336. Attention: Code Enforcement.
Property Information: (Please Print or Type)
Property Address ____________________________ City ___________________ State ___________
Zip ________ Subdivision: Parcel ID_____________________________________________________
Book _____________________ Page _____________________ Date filed______________________
What is this property's Legal Status (Foreclosure, Short Sale, Auction, Rental, Occupied, etc ... )
___________________________________________________________________________________
New Building Owner or Rental Information:
Name:__________________________Address:____________________________________________
City:____________________________State:_____________________Zip:______________________
Phone#_______________________Fax#______________________Email_______________________
Mortgagee Information: (If different than building owner)
Name:___________________________Address:___________________________________________
City_____________________________State ____________________Zip_______________________
Phone#_______________________Fax#__________________Email___________________________
24 Hr. Emergency Contact:
Name: _________________________Address: ____________________________________________
City_________________________________State _______________________ Zip _______________
Phone#_______________________Fax#______________________ Email ______________________
Agent, Owner requesting removal:
Name: ________________________ Address: _____________________________________________
City________________________________ State _______________________ Zip________________
Phone#_______________________Fax# _____________________Email _______________________
REGISTERED ABANDONED AND VACANT
BUILDING REMOVAL FORM
1 OF 2
Required Notarization:
Registration form completed by:_____________________________________________________
Title: ____________________________________________________________________________
Signature: ___________________________________________ Date: _______________________
State of _____________________________________.
County of ___________________________________.
The foregoing instrument was sworn to and subscribed before me, the undersigned Notary
Public on this, the _______________ day of _______________ , 20 ______________.
WITNESS my hand and official seal
(Signature of Notary Public)
(type of identification produced)
Printed,
typed or stamped name of Notary Public Exactly as commissioned
Notary
Public,
State of
___________________________________________
Personally known to me, or produced identification:___________________________________
REGISTERED ABANDONED AND VACANT
BUILDING REMOVAL FORM
2 OF 2
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REGISTERED ABANDONED AND VACANT BUILDING REMOVAL FORM (Fulton County Government)

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Completed 6 August 2020

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