Certified Survey Affidavit Form
Download a blank fillable Certified Survey Affidavit Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Certified Survey Affidavit Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1MontAnA
LCD 3
Clear Form
SURVEY
Rev 11 14
Certified Survey Affidavit
Street Address of Proposed Premises ___________________________________________________________________
City ______________________________________County _________________________________________________
In the case of a location outside the corporate boundary, include the following:
I, _____________________________________, am a
County Surveyor
City Surveyor
Private Licensed
Land Surveyor and have the knowledge and the authority to attest that the distance was measured by radial survey
method from the nearest corporate city boundary to the nearest entrance of the proposed premises known as
_______________________________(Business Name). Plat(s)/map(s) verifying the location that indicate the points
between which the measurement was made and the distance can be provided upon request.
In the case of a location inside the corporate boundary, include the following:
I, _____________________________________, am a
County Surveyor
City Surveyor
Private Licensed
Land Surveyor and have the knowledge and the authority to attest to the location of the premises known as
_______________________________ (Business Name) was determined by examination of corporate plats or other
official records.
Location of Premises (check one)
Within the incorporated boundaries of ___________________________________ (Name of City)
kdkdk
Less than five miles from the nearest corporate boundary of ________________________________ (Name of City)
kfkfkkdk
More than five miles from any incorporated city within ___________________________________ (Name of County)
If the premises is outside an incorporated city, please provide the exact distance (in hundredths of a mile) from the nearest
corporate boundary to the nearest entrance of the premises.
.
0 2 1
5 4
By signing this form, I recognize state law requires the distance be measured in a straight line from the nearest entrance
of the premises proposed for licensing to the nearest corporate boundary of the city or town.
__________________________________________
_______________________________
Signature
Title
Surveyor License or Registration Number
_____________________________
Subscribed and sworn to before me this ______________day of __________________20__________.
On this________________day of____________________20__________.
Personally appeared __________________________________________
notary Seal
before me a Notary Public for the State of _________________________
____________________________________________ Notary Signature
_________________________________________ Print Name of Notary
My Commission Expires __________ Month, Day and Fourth digit of Year
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial