Fillable TOWN OF PINE PLAINS PLANNING BOARD OWNER AUTHORIZATION (Town of Pine Plains)

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TOWN OF PINE PLAINS PLANNING BOARD OWNER AUTHORIZATION (Town of Pine Plains)

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TOWN OF PINE PLAINS PLANNING BOARD
OWNER AUTHORIZATION FORM
To be filed when the applicant is authorizing another individual to act on their behalf in all
proceedings before the Planning Board.
Date:____________________________
Tax Map No._____________________
Location:______________________________________________________________
Owner Name and Address:
_______________________________________________
_______________________________________________
_______________________________________________
Telephone Number:__________________________ Email: _____________________________
Name of Authorized Representative:__________________________________________
I hereby authorize (representative name)_______________________________________
to act on my behalf in all proceedings before the Town of Pine Plains Planning Board concerning
my application.
_______________________________________
Owner’s Signature
_______________________________________
Owner’s Signature
Sworn to me this_____________day of
_____________________,_________.
_______________________________
(Notary Public)
ownerauthorizationform.doc (3-10)
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TOWN OF PINE PLAINS PLANNING BOARD OWNER AUTHORIZATION (Town of Pine Plains)

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Completed 14 July 2020

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