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Amnesty Program Application

2. Application Fees:
   $50.00 - Residential, owned home for more than two years
   $100.00 - Residential, owned home for less than two years
   $500.00 - Commerical Property
   
4. Property Owners First Name*
5. Last Name*
7. Property Address
9. City
10. State
11. Zip
13. Folio Number*
14. Driver's License Number*
16. Telephone*
17. Email*
19. Mailing Address (if different)
23. Electronic Signature*
24. I understand that checking this box constitutes a legal signature confirming the information I have completed is true*

    1. Yes
    2. No
28. Total Fine/Lien Amount
29. Application Fee Paid?

    1. Yes
    2. No
31. Reduced Amount
33. Financials Reviewed By
34. Signature
36. Code Enforcement Date of Inspection
37. Compliance

    1. Yes
    2. No
39. Code Enforcement Inspector's Name
40. Signature
42. Director's Action

    1. Approved
    2. Denied
43. Affidavit Received

    1. Yes
    2. No
45. Department Director's Signature
47. City Manager Signature
48. Date
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field