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Street Addredi <br />Interest in Prop rty ( ecl p opriate box) <br />Ownerrof Property` <br />Contract for_ Deed:Ownera <br />L see .Operator'Managet <br />Agreement to- - urchase <br />iO h `(eexpplain\/ <br />eneral=Location- a <br />present Use , (check appropr ate box) . <br />Uncle op � ./Yaca <br />SingIFam'1Iy Dwelfng <br />Duplex/Two:= Family: Dweilin <br />.M mil No'" nits`.' .• rc 'y; _�. <br />:Bustness/Comme . -: stablishmen <br />;Industnat_ Establiishment. <br />-Other(explain) x " <br />[ HEREBY DECLARE THAT;THE ABOVEfSTATEMENT ARE`TRUE �- i 4 . <br />�f ignature <br />***'A'*'k*****'k'*****************ittC�********************************************* - <br />... .. -' . ,_ieA�a•4aYVBwsci.�•iw r__ _ -... �. _.-. ,. _. <br />_$200/acre, minimum:$200, ma dmu n.$1,000 <br />%R-t'io R-2 = 1.5;. 1 others $20o <br />R41:19 R-2 - $75. aq others $200 <br />..$75' <br />$100/a►cre minimum <br />• S75a <br />s250 plus $250 deposit <br />$200 <br />:$5k plus deposit deter hired • y <br />.: <br />$350,_ <br />$150..r <br />TOTAL FEES PAID <br />-DATE. PAID: <br />RECEIPT. NUMBER <br />Date oUsnalaction <br />APPROVED 0 =Y DENIED 0,,� TABLED k0 <br />'t 8-:4 owe' yam- Admfn:.Account No:— <br />