gov revenue formsandresources forms Survey_Fill-in

259 views

Published on

Published in: Business, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
259
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

gov revenue formsandresources forms Survey_Fill-in

  1. 1. MONTANA Survey Rev. 10-07 Certified Survey Affidavit Street address of proposed premises________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ City ______________________________ County_____________________________________ I,__________________________________ , am a  County Surveyor,  City Surveyor,  Private Licensed Land Surveyor, (check one) and have the knowledge and authority to attest to the location of the premises known as _____________________________________ (trade or business name). The location of this premises is: (check one) within the corporate boundaries of __________________________________________ (city),  within five miles of the corporate boundaries of ________________________________ (city),  more than five miles from the incorporated city of ______________________________ (city).  The distance was measured by radial survey method from the nearest corporate city boundary to the nearest entrance of the proposed premises. Plat(s)/map(s) verifying the location that indicate the points between the measurement was made and the distance can be provided upon request. If the premises is outside an incorporated city, please state the exact distance from the nearest corporate boundary to the nearest entrance of premises _____ (distance in hundreths of a mile). By signing this form, I recognize state law requires the distance be measured in a straight line from the nearest entrance of the premises proposed for licensing to the nearest corporate boundary of the city or town. __________________________________________ Signature __________________________________________ Title On this ___________________day of ______________________________20 ______ Personally appeared _____________________________________________________ Before me a Notary Public for the State of ____________________________________ Notary Seal ________________________________________________________ (Notary signature) _____________________________________________________ (Print name of notary) My Commission Expires _____________________________ (Month, day & 4-digit year) 507

×