Form Date: 8/9/07 Page 1 of 2
CITY OF VISALIA Disclosure Development Project INCOMPLETE OR LATE SUBMISSION OF DISCLOSURE STATEMENT COULD RESULT IN CONTINUANCE OR DELAY OF YOUR PROJECT. SITE:Address or APN(s): _________________________________________________________________________________Short Title or Name of proposed project: _________________________________________________________________Summary description of the proposed project: _______________________________________________________________________________________________________________________________________________________________ PROPERTY OWNER(S): If more than two owners, please provide information and signature(s) on a separate sheet. Name (print) _____________________________________ Name (print) ______________________________________ Mailing Address _________________________________ Mailing Address __________________________________________________________________________________ _________________________________________________ Phone _________________________________________ Phone ___________________________________________ Statement: I/We declare under penalty of perjury that I am/we are the legal owner(s) of the property involved in this application. I/We authorize the person named in this application as the Project Main Contact to act as my/our representative with City Staff regarding the processing of this application. _______________________ ____________________________________________ Date Property Owner Signature ____________________________________________ Print Name & Title _______________________ ____________________________________________ Date Property Owner Signature ____________________________________________ Print Name & Title OTHER INVOLVED PARTIES: Fill in all that apply. It is planned that the property will be sold to ______________________________________________________________(Write “none” if property owner(s) do not plan to sell property.) Developer/Builder __________________________________________________________________________________ Mailing Address ____________________________________________________________________________________ Phone _____________________ Fax _____________________
Form Date: 8/9/07 Page 2 of 2
NAMES OF PRINCIPALS, PARTNERS, AND/OR TRUSTEES: List the names of all principals, partners, and/or trustees where any property owner and/or developer/builder are a partnership or trust. For corporations provide names of officers, directors and all stockholders owning more than 10% equity interest in corporation:
NOTICE: If the above information regarding ownership and interest in this property changes before the project goes before City Council or Planning Commission, it is the responsibility of such parties to notify the City of Visalia of this change(s).
Form Date: 8/9/07 Page 1 of 2
CITY OF VISALIA Disclosure Development Project INCOMPLETE OR LATE SUBMISSION OF DISCLOSURE STATEMENT COULD RESULT IN CONTINUANCE OR DELAY OF YOUR PROJECT. SITE:Address or APN(s): _________________________________________________________________________________Short Title or Name of proposed project: _________________________________________________________________Summary description of the proposed project: _______________________________________________________________________________________________________________________________________________________________ PROPERTY OWNER(S): If more than two owners, please provide information and signature(s) on a separate sheet. Name (print) _____________________________________ Name (print) ______________________________________ Mailing Address _________________________________ Mailing Address __________________________________________________________________________________ _________________________________________________ Phone _________________________________________ Phone ___________________________________________ Statement: I/We declare under penalty of perjury that I am/we are the legal owner(s) of the property involved in this application. I/We authorize the person named in this application as the Project Main Contact to act as my/our representative with City Staff regarding the processing of this application. _______________________ ____________________________________________ Date Property Owner Signature ____________________________________________ Print Name & Title _______________________ ____________________________________________ Date Property Owner Signature ____________________________________________ Print Name & Title OTHER INVOLVED PARTIES: Fill in all that apply. It is planned that the property will be sold to ______________________________________________________________(Write “none” if property owner(s) do not plan to sell property.) Developer/Builder __________________________________________________________________________________ Mailing Address ____________________________________________________________________________________ Phone _____________________ Fax _____________________