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MARICOPA COUNTY DEPARTMENT OF TRANSPORTATION 2901 W. Durango Street e Phoenix, AZ 85009 Phone: (602) 506-4176 PATENT EASEMENT ABANDONMENT APPLICATION Pe Te aS CO ACUMEN 2 eae earner ET Applicant Name: __ \/A.5 1Lé TUPITA PAB Number: Mailing Address: 26113 A/ /Ith Ave city: Pheeniy state: AZ zip: SSOIS Phone (002.)-_J43 -_ 3237 Assessor's Parcel Number: 210-049 - 926 é 1. Location of Request: (ex: 3200 W. Dove Valley Road, Phoenix) 152M ath Ave , Phoenix, Ar. 95025 2. Description of Request: (ex: Abandon Easement bordering the South side of parcel 123-45-067A) Abandon te +he full est_extent poasi ble 3. Applicant is REQUIRED to be the current owner of the described property. A copy of your property deed must be attached to the application. I certify, under penalty of perjury, that no loss of currently existing legal and physical access to any property will occur if the County grants the patent easement abandonment requested in this application. 4. If you have a mortgage, deed of trust, upon your property you are REQUIRED to provide a letter from the lender approving your request to abandon a patent easement. Applications submitted without lender approval will not be processed. If you don’t have a mortgage or deed of trust on the subject property, you will need to sign, before a notary, the affidavit below attesting to that status. L U ASILG T Uf TA attest that I own the subject property and that it is not encumbered by mortgage or deed of trust. Subscribed and sworn to before me this My Commission Expires: 63 /2(@ /Z02/ ~~ day of 2020 fe ALEKSANDRA KARAC 8 Notary Public - Arizona B | Maricopa County a7 My Comm. Expires Mar 26, 2021 Notary Public — o1.17. 2020 Signature of Applicant Date Application Fee*: $1,600 Check #: Total Received: Date: Rec'd By: *Application Fee will be $1,350 ($1,600 less $250) if Initial Determination letter is provided; demonstrating an initial review of the parcel was conducted by the County within the last six months. The application fee is NOT refundable. Make checks payable to: MCDOT 2901 West Durango Street Phoenix, AZ 85009.