Fillable Village of Sag Harbor Change Request Form 2021 (Incorporated Village of Sag Harbor)

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Village of Sag Harbor Change Request Form 2021 (Incorporated Village of Sag Harbor)

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The Village of Sag Harbor Change Request Form 2021 (Incorporated Village of Sag Harbor) form is 1 page long and contains:

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Country of origin: US
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U.S.A. forms for Incorporated Village of Sag Harbor

BROWSE INCORPORATED VILLAGE OF SAG HARBOR (NY) FORMS

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Village of Sag Harbor
Change Request Form
P.O. Box 660 · 55 Main Street · Sag Harbor, NY · 11963
Phone: 631-725-0222 · Fax: 631-725-0316
2021 CHANGE REQUEST FORM
Name____________________________________________________ Phone________________________________
Mailing Address____________________________________________ Email________________________________
____________________________________________ Resident/Non-Resident__________________
Residents must provide proof of residency as stated in the Berthing Agreement
Current Location__________________________ Request Change to: _______________________________
Mooring____Dinghy_____Cable_____A-Dock_____B-Dock_____Marine Park_____
Reason for Change Request___________________________________________________________________
__________________________________________________________________________________________
Boat Name________________________________________________________________________________
Registration/Documentation#____________________ Year/Make/Model_______________________________
Type: Power______Sail_______ Length Overall________ Width_______Draft_________
If you will be docking a different boat from the one currently assigned to your slip, please complete a new berthing
agreement and provide a copy of the registration and insurance for the new boat.
New Boat Name____________________________________________________________________________
Registration/Documenation#_____________________ Year/Make/Model______________________________
Type: Power______Sail_______ Length Overall________ Width_______Draft_________
S
IGNATURE____________________________________________________________ DATE_____________________________________
Please email completed change request to accountclerk@sagharborny.gov or mail to the address listed above:
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Village of Sag Harbor Change Request Form 2021 (Incorporated Village of Sag Harbor)

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Completed 19 January 2021

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