Release And/or Occupation Of County Easement - Affidavit Form

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Charlotte County
Release and/or Occupation of County Easement
AFFIDAVIT
VERIFICATION OF AN EXECUTED CONTRACT FOR PURCHASE AND SALE OF REAL
PROPERTY
This affidavit is submitted as part of an application for the release and/or
occupation of County easement(s) located on the following referenced
property.
1. Property Identification
a. Street Address
b. City
c. Short Legal Description
Lot(s)
Block
Subdivision
Section
Other
d. Property Appraiser’s Account Number
2. Name of Legal Owner of the Real Estate (Seller)
3. Name of the Contracted Purchaser of the Real Estate (Applicant)
4. A contract for Purchase and Sale of the above referenced property was executed between the Buyer
(applicant) and the Seller (Legal Owner of the Property) on the
day of
, 20__.
5. The contracted closing date is ____________________________.
I, the undersigned, being first duly sworn, dispose and say that I an the applicant identified above and that all
the answers to the questions contained on this affidavit are honest and true to the best of my knowledge and
belief. I understand that this affidavit must be complete and accurate before the review of the accompanying
Application for Release and/or Occupation of County Easement can be undertaken by the Real Property
Services Department of Charlotte County, on my behalf.
STATE OF ________________________
COUNTY OF ______________________
The foregoing instrument was acknowledged by me this________, of___________________,
20__, by _____________________________, who is personally known to me/provided
identicfication.
My Commission Expires:
____________________________________
Notary Public
____________________________________
Printed Name
_____________________________
For County Use Only
File Number
Date Received

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