HomeMy WebLinkAboutProperty Owner Declaration Form v3 2.16.2022
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County of Hawaiʻi
DEPARTMENT OF PUBLIC WORKS
PROPERTY OWNER DECLARATION FORM
INSTRUCTIONS
COMPLETE THE SECTIONS BELOW. AN EMAIL ADDRESS IS REQUIRED FOR ALL CONTACTS – ALL
COMMUNICATION REGARDING YOUR APPLICATION WILL BE EMAILED.
LOCATION INFORMATION
(VERIFY AT: www.hawaiipropertytax.com/search.html)
PARCEL NUMBER
LOCATION ADDRESS
PROPERTY OWNER INFORMATION (Owner contact information is required)
(VERIFY AT: www.hawaiipropertytax.com/search.html)
IF PROPERTY OWNER(S) NAMED BELOW DOES/DO NOT MATCH THE COUNTY’S REAL PROPERTY TAX
OFFICE RECORD, PLEASE SUBMIT A COPY OF THE CURRENT OWNER’S PROOF OF OWNERSHIP.
OWNER NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
OWNER NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
OWNER NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
LESSEE/TENANT INFORMATION
LESSEE/TENANT NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
LESSEE/TENANT NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
Hawaiʻi County is an equal opportunity provider and employer
v3 2/16/2022
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County of Hawaiʻi
DEPARTMENT OF PUBLIC WORKS
ADDITIONAL CONTACT INFORMATION (LIMIT 2)
AGENT NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
AGENT NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
I hereby certify that I am the owner of the property listed above and all information provided is accurate
and complete. I understand that all contacts listed above will receive communication regarding my permit
application and plans.
CHECK THE BOX IF
PROPERTY OWNER
INFORMATION ABOVE
MATCHES RPT’S DATA.
If no , proof of ownersh ip i s
required. Verify at:
www.hawaiipropertytax.com/
search.html
PROPERTY OWNER (PRINT)
PROPERTY OWNER (SIGNATURE) Date
Hawaiʻi County is an equal opportunity provider and employer