Date: ________________________ To: The Monroe
County Mapping Department Re: Request for the merger of the following
parcels I am requesting that the Irondequoit Assessing Office process
my request that the parcels listed below be merged into one parcel.
(Main parcel number to remain is checked below by the Town Assessor.)
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Tax No.
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Location
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Lot No.
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Acreage
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---|---|---|---|---|
____________
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___________
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________
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_______
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____________
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___________
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________
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_______
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____________
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___________
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________
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_______
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I am the owner of the above listed property
and do hereby swear that the statements contained in this application
are true. I understand that this request is permanent and if I wish
to separate them in the future, I will have to go through a formal
subdivision process and be required to meet all current zoning laws
and restrictions. I also understand that once combined the parcel(s)
may not be able to be subdivided because it/they may not meet the
current subdivision requirements.
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OWNER:
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Print Name ______________________
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Signature _________________
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Print Name ______________________
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Signature _________________
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Print Name ______________________
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Signature _________________
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STATE OF NEW YORK )
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COUNTY OF MONROE ) SS:
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On the _______________ day of ______________,
____, before me, the undersigned, personally appeared ___________________
personally known to me or proved to me on the basis of satisfactory
evidence to be the individual(s) whose name(s) is (are) subscribed
to the width instrument and acknowledged to me that he/she/they executed
the same in his/her/their capacity(ies) and that by his/her/their
signature(s) on the instrument, the individual(s), or the person upon
behalf of which the individual(s) acted, executed the instrument.
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_____________________
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NOTARY PUBLIC
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BELOW THIS LINE FOR OFFICE USE ONLY
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Approved _______________________________ date
__________, 2001
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(Assessor)
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Approved _______________________________ date
__________, 2001
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Attached
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(Planning and Zoning)
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