HomeMy WebLinkAboutGEOTHERMAL RELOCATION PROGRAM FORM
GEOTHERMAL RELOCATION PROGRAM
CERTIFICATION OF PROPERTY OWNER
Tax Map Key Number: _______________ _
I CERTIFY, SWEAR AND AFFIRM THAT:
I am the owner of the above referenced property;
Date:__________
The above referenced property is within a one (1) mile radius of the Puna Geothermal Venture
facility;
The dwelling is a permitted structure and has been inspected and finalized by the County of
Hawai'i Department of Public Works, Building Division;
I occupy the above referenced property as my primary residence;
Improvements upon the above referenced property conform with applicable State and County
laws, codes, ordinances, rules and regulations; and
I wish to relocate and sell my property to the County of Hawai'i under the Geothermal
Relocation Program.
I understand that in the event that funds are initially insufficient to purchase all of the dwellings and
properties, those purchased before October 3, 1989 followed by those located closest to the Puna
Geothermal Venture facility shall be negotiated first.
Signature
Mailing Address
Telephone Number
_
STATE OF HAWAl'I_ ) ss.
COUNTY OF HAWAl'I ___ )
I, undersigned, a Notary Public in and for
Print Name
Email address
said State of Hawai'i, hereby certify that
_________, is signed to the foregoing certification, and who is known to me, swore and
acknowledged before me on this day that, being informed of contents and the penalties of perjury,
he/she swore to and executed the same voluntarily on the day the same bears date.
GIVEN under my hand and official seal of office, this ___ day of ________ 20
Notary Public
My Commission Expires: ________