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JNSY Of H,,w1 <br />tQ • i4.. \ � <br />A1II�4iClunN of �Pa(llal 1,DEPARTMENT OF PUBLIC WORKS <br />PROPERTY OWNER DECLARATION FORM <br />MS FIRUC FIINS <br />COMPLETE THE SECTIONS BELOW. AN EMAIL ADDRESS IS REQUIRED FOR ALL CONTACTS —ALL <br />COMMUNICATION REGARDING YOUR APPLICATION WILL BE EMAILED. <br />LO C T IO N II N F CS IR T I1 � lIII_�1�.._�_�_�:�... F.a.._ E R.11: Y...II..Q..CAT!_O rv..i_N_FO R I.01N. ) <br />PARCEL NUMBER <br />LOCATION ADDRESS <br />IP IR O IP E IRTY OWNER IINIFORMAF110N (Q riser contacunLormation is reuir ed) <br />I...IICK IINERIf: 'TO VERIFY PROPERTY O` IN E�IRSII..NII_I <br />....................................................................................................................................................................... <br />IF PROPERTY OWNIE.R(S) NAMED BEI OW I[)OF..S/[)O NOT MATCH Tl --NE COUNTY'S REAL.. If)R0PIERTY TAX <br />OFFICE RECORD, PI EASE SUBMIT A COPY OF THE CURRENT OWNER'S PROOF OF OWNERSHIP. <br />OWNER NAME <br />MAILING ADDRESS <br />PHONE NUMBER <br />EMAIL <br />OWNER NAME <br />MAILING ADDRESS <br />PHONE NUMBER <br />EMAIL <br />OWNER NAME <br />MAILING ADDRESS <br />PHONE NUMBER <br />EMAIL <br />LESSEE/TENANT INFORMA F110N <br />LESSEE/TENANT NAME <br />MAILING ADDRESS <br />PHONE NUMBER <br />EMAIL <br />LESSEE/TENANT NAME <br />MAILING ADDRESS <br />PHONE NUMBER <br />EMAIL <br />Hawai'i County is an equal opportunity provider and employer <br />