STATE OF NEW YORK ) AFFIDAVIT IN SUPPORT
OF REQUEST FOR A
COUNTY OF SUFFOLK ) CERTIFICATE OF EXISTING USE
FIRE ISLAND
I,
, being duly sworn, submit this affidavit in support of the
application of
for a Certificate of Existing Use.
1. The property is located at #
N S E W side of
Distance
N S E W of Hamlet
Suffolk County Tax Map: Section
Block Lot (s)
2. The subject parcel of land consists of approximately square feet.
3. List all structures and uses existing on the subject premises
prior to the applicable date. Fill in
how many of each structure and its use.
Structures (#) Uses (described)
One Family Dwelling
Two Family Dwelling
Garage (detached)
Barn
Shed
Business
Other
Other
I know that the structures and uses listed above have been continuous since the year
because I have been familiar with the subject premises since the year
4. The following structures or uses were added
after the applicable date:
. If none, so state:
5. Was the use of the subject premises discontinued for a period of one year or more?
Yes
No If yes, explain:
6. Has said parcel been reduced in lot area? Yes
No If yes, state the year
reduced and explain:
7. I am
years of age. Date of birth .
● Please print: Your name
Address
Telephone
● I am not related to the owner nor do I have a financial interest in the subject property.
● I understand that I am executing a legal document and that providing false information will result
in rejection of this affidavit and potential prosecution for perjury.
(Signature of Affiant)
Personally appeared before me the above named
personally known to me,
who being duly sworn, deposes and says that he/she executed the above instrument and that the statement and
answers contained therein are true and correct to the best of his/her knowledge and belief.
Subscribed and sworn to before me this
day of ,20________.
7-2006 (Notary Public)
