Application For Combining Parcels Of Land Form - Surry County Tax Administration
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1INDIVIDUAL
SURRY COUNTY TAX ADMINISTRATION
P.O. BOX 588
DOBSON, NC 27017
(336) 401-8100
APPLICATION FOR COMBINING PARCELS OF LAND
________________________________________________________________________
NAME
_____________________________________________________________________
ADDRESS
HOME TELEPHONE_______________________ WORK TELEPHONE_______________________
Parcels of land are mapped by legal description found on recorded deeds, recorded plats, and by probated estates
established by will. Ownership names on parcels of land may be changed only by recorded deeds. Contiguous
parcels that are recorded under the same ownership name may be mapped as a single parcel for property taxation
purposes without a recorded deed only if this request is signed, notarized, and submitted to the Surry County Tax
Administration. This action MUST be approved by the Surry County Planning Department prior to the combination
process. This procedure does not affect such things as insurance, mortgages, legal descriptions, or any other
information indicated by deed.
LIST THE PARCELS BY PARCEL IDENTIFICATION NUMBER (PIN) WITH DEED BOOK AND
PAGE NUMBER THAT CORRESPONDS TO EACH PARCEL. EACH PARCEL LISTED ON THIS
FORM WILL BE COMBINED INTO ONE PARCEL PROVIDING THEY ARE ALL CONTIGUOUS
PARCELS. IF YOU REQUIRE A SEPARATE COMBINATION, YOU MUST USE A SEPARATE
FORM OR FORMS.
PARCEL ID_________--______--______--__________--______ DB___________ PG____________
PARCEL ID_________--______--______--__________--______ DB___________ PG____________
PARCEL ID_________--______--______--__________--______ DB___________ PG____________
PARCEL ID_________--______--______--__________--______ DB___________ PG____________
PARCEL ID_________--______--______--__________--______ DB___________ PG____________
PLEASE BE ADVISED THAT ALL COMBINATIONS WILL BE DONE ON A FIRST COME, FIRST SERVED
BASIS AFTER THE REGULAR PROCESSING OF RECORDED DEEDS. PLEASE ALLOW 60 DAYS FOR
THIS REQUEST TO BE REVIEWED FOR PROCESSING.
FOR OFFICE USE ONLY
DATE RECEIVED IN OFFICE______/_____/______ DATE PROCESSED_____/______/______
Y
N
PLANNING APPROVAL
/
PLANNING SIGNATURE________________________
MAPPER’S INITIALS
LAND RECORDS INITIALS
_______________
_______________
NEW PIN___________--________--________--____________--________
CALCULATED ACREAGE_______________________________________
PROPERTY OWNERS AFFIRMATION: BY MY (OUR) SIGNATURES, I (WE) ACKNOWLEDGE THAT I
(WE) ACCEPT FULL RESPONSIBILITY FOR THE COMBINATION OF THE PARCELS REFERENCED
HEREIN INTO A SINGLE PARCEL EVEN THOUGH SEPARATE DEEDS MAY BE RECORDED FOR EACH.
SIGNATURE OF APPLICANT____________________________________________ DATE_____/_____/______
NOTARY STATEMENT
North Carolina
____________________ County
I,___________________________________________, a Notary Public for said County and State, do hereby certify
that_________________________________________ personally appeared before me this day and acknowledge the
due execution of the foregoing instrument. Witness my hand and official seal, this the _______day of___________
20___.
___________________________________________
Notary Public
My commission expires _____________________________________, 20_____.
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