Pitt County Forms Center

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   1717 W 5th Street Greenville, NC 27834  |  Telephone: (252) 902-3250

   Application to Lease Buyout Property

    

4. Date:*
   Date:
7. Tax Parcel Number or Address of Buyout Property: *
9. Are you the former owner of the property?*
   -- Select One --YesNo
10. Do you own the adjacent property?*
    -- Select One --YesNo
11. Do you own property in the vicinity? *
    -- Select One --YesNo
13. First Name*
14. Last Name*
16. Address*
18. City*
19. State
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
20. Zip Code*
22. Phone Number*
23. Alternate Phone Number:
24. Email Address*
26. What is the proposed use of the property? (Please be specific):*
28. How do you propose to maintain the property?*
30. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
32. Electronic Signature*
Leave This Blank:


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