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Amnesty Program Application

2. Application Fees:<BR> $50.00 - Residential, owned home for more than two years<BR> $100.00 - Residential, owned home for less than two years<BR> $500.00 - Commerical Property<BR>

   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