TOWN OF RAMAPO
Building, Planning & Zoning Department
Phone: (845)357-5100 Fax: (845)357-5140
TITLE AND LIEN STATUS CONFIRMATION TO THE TOWN OF RAMAPO
In order to issue a Demolition Permit, the Town requires information on any Record Property Owner,
Mortgage Holder or other Lien Holder to review any Demolition Permit Application. Therefore, the
following information must be provided under the penalty of perjury:
DATE: ___________________________
SECTION & LOT # WHERE DEMOLITION WILL OCCUR: ____________________________________
PUBLIC RECORD PROPERTY OWNER NAME: ____________________________________________
ADDRESS: ______________________________ TELEPHONE # _________________________
EMAIL:_______________________________
APPLICANT’S NAME: _________________________________________________________________
ADDRESS: ______________________________ TELEPHONE # _________________________
EMAIL:________________________________
List the names and addresses of all Mortgagees that have a lien against this Property
(if needed attach additional pages)
Name Address
___________________________ ___________________________________
___________________________ ___________________________________
___________________________ ___________________________________
List the Names and addresses of all other Lien Holds that have a lien against this Property
(if needed attach additional pages)
Name Address
___________________________ ______________________________
___________________________ ______________________________
___________________________ ______________________________
For each Mortgagee and Lien Holder a notarized letter providing consent to the Town’s issuance
of any Demolition Permit must be provided dated within 30 days of any such Permit Application.
CERTIFICATION AS BEING CORRECT AND TRUE:
The undersigned hereby affirms or swears that the information contained in this document is correct and
true as of the date of this document and knows the Town of Ramapo will rely on the accuracy of this
information when reviewing and issuing any Demolition Permit.
Name:_____________________________________ Title:____________________________________
Signature: __________________________________
Sworn or affirmed as being correct and true under the penalty of perjury on ________________________
___________________________
Notary Public, State of New York
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