Letter of Interpretation Application

(Note:  A ".pdf" version of this document is available at this link.)

(BROOKHAVEN PURCHASE MUST BE RECEIVED ON OR BEFORE
SEPTEMBER 6, 2001 AT 12:00 NOON NEW YORK TIME)
 

OWNER INFORMATION


Property Owner's Name: _________________________ Phone Number: (___)__________

Co-Owners Name: ______________________________ Phone Number: (___)__________

Email address: _________________________________

Mailing Address: ___________________________________________________

___________________________________________________

___________________________________________________
 

PROPERTY INFORMATION


Suffolk County Tax Map Number: ______- ______-______-______
(This number is located on the top left corner of your tax bill under the heading Suffolk County Tax Map 

Size (as indicated on tax bill): ______

Please describe any structures on the property and/or any clearing of the property and give approximate dates of such activity (ies):
____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Is there a mortgage or lien on the property? ___

If yes, what is the amount of the outstanding principal? $_____

Do you have any surveys of the property? ____ Please submit the surveys with this application.

Please submit a copy of your tax bill and deed with this application.
 

REPRESENTATIVE INFORMATION


Do you authorize a person to act as your representative in all matters pertaining to this application? ___

If yes, whom do you designate? ________________________________________________

Phone number of representative: (___)__________ 

Mailing Address: ___________________________________________________

___________________________________________________ 

___________________________________________________
 


 

OWNER CERTIFICATION


I hereby certify that the information furnished on this application is true. I hereby authorize the staff or other representatives of the Central Pine Barrens Joint Planning and Policy Commission to conduct site inspections on the property as are necessary to review this application.

___________________________________________ _______________

Signature of Owner Date 

___________________________________________ _______________

Signature of Co-Owner (Co-Applicant) Date
 


 

PLEASE MAIL COMPLETED APPLICATION AND MATERIALS TO:

PINE BARRENS CREDIT CLEARINGHOUSE
P.O. BOX 587
GREAT RIVER, NEW YORK 11739-0587
______________________________________________________________________________

BY EXPRESS MAIL DELIVERY OR HAND DELIVERY TO:

PINE BARRENS CREDIT CLEARINGHOUSE
3525 SUNRISE HIGHWAY
2ND FLOOR
GREAT RIVER, NEW YORK 11739