HCDD Not a Rental/Owner Occupied/Unoccupied Form

State
County
TO WIT:
I am competent to be a witness in a judicial proceeding, am over 18 years of age and have personal knowledge of the facts asserted herein.
I am the owner of the property located at
Address
Salisbury, Maryland, (hereinafter referred to as "Property"). I am personally familiar with the Property and its occupancy.
The property is currently
- Owner Occupied
- Unoccupied
- Non Rental
- Not Vacant
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
If the information provided herein is found to be falsified, you may be subject to a $500/day citation.
Owners Digital Signature*

Please type your name above acting as your digital signature.