REQUEST FOR RELIEF CHECK OFF LIST - Miami Shores Village

Miami Shores Village
Code Enforcement Board
APPLICATION FOR REQUEST FOR RELIEF
OWNER (S) NAME: ___________________________________________
TELEPHONE NUMBER: _______________________________________
MAILING ADDRESS: __________________________________________
ADDRESS OF LIENED PROPERTY: _____________________________
CASE No. DATE OF LIEN (S) CURRENT AMOUNT
TOTAL: $_________________
REASONS WHY RELIEF SHOULD BE GRANTED (attach additional sheets if
necessary) _________________________________________________________
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**Proposed amount must be greater than $0.00 in order for this application to be accepted. **
TOTAL AMOUNT WHICH YOU PROPOSE TO OFFER: $____________
I (WE) request relief from the above referenced liens for the reasons herein set forth
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SIGNATURE OF APPLICANT
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SIGNATURE OF APPLICANT
Request for Relief