HomeMy WebLinkAboutSingle Family Dwelling Owner Affidavit
DEPARTMENT OF CODE ENFORCEMENT
215 N. Tioga St 14850
607.273.1783
codes@town.ithaca.ny.us
SINGLE FAMILY DWELLING AFFIDAVIT
OWNER(S) NAME
MAILING ADDRESS
PROPERTY LOCATION
TAX PARCEL NUMBER
STATEMENT
I, , hereby declare that the property situated on Town
of Ithaca Tax Parcel No. known as is a contains one single
family dwelling unit. This property is not divided for any other use than a single-family dwelling. I understand
that a dwelling unit is a space that provides sleeping, sanitary, cooking and living facilities in an independent
area, separate from the rest of a building's facilities. No part of my building, including the basement or cellar,
or any other portion of my property, including an accessory building, is utilized or will be utilized for a second
dwelling unit. Furthermore, no charges or fees are paid by a tenant for occupying a second dwelling unit.
I further declare that I will notify the Town of Ithaca of any change in the situation described above; and that I
hereby agree that any person duly authorized by the Town of Ithaca, upon identification of themselves and a
declaration of their purpose, shall have the right, on two days’ notice, to examine the owner's property and
records, and to enter upon and inspect the premises, and to inquire into the use and rental status of any
portion of the structure on said property. I understand that by signing this affidavit that to add a second dwelling
unit would require that my property be permitted to have a second dwelling unit and a building permit would
need to be approved and issued by the Town of Ithaca.
I certify, under penalty of perjury, that the above statements are true and correct.
Date Owner Signature
Subscribed and sworn to before me this _ day of 2022.
SEAL
Notary Public