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Amnesty Program Application
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This form has been modified since it was saved. Please review all fields before submitting.
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
Property Owners First Name
*
Last Name
*
Property Address
City
State
Zip
Folio Number
*
Driver's License Number
*
Telephone
*
Email
*
Mailing Address (if different)
Electronic Signature
*
I understand that checking this box constitutes a legal signature confirming the information I have completed is true
*
Yes
No
Total Fine/Lien Amount
Application Fee Paid?
Yes
No
Reduced Amount
Financials Reviewed By
Signature
Code Enforcement Date of Inspection
Compliance
Yes
No
Code Enforcement Inspector's Name
Signature
Director's Action
Approved
Denied
Affidavit Received
Yes
No
Department Director's Signature
City Manager Signature
Date
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