2024-02-08 -PC 560 -PAB-0229-APPLICATION.PDF

MARICOPA COUNTY DEPARTMENT OF TRANSPORTATION 
2901 W. Durango Street• Phoenix, AZ. 85009 
Phone: (602) 506-4889 
PATENT EASEMENT ABANDONMENT APPLICATION 
Note: Completed forms may be submitted to 
_ 
or mailed to the MCDOT office. 
Incomplete applications may result in delay of review. 
Contact Information 
Applicant Name: N\Prf?,.K, 'SA l Lt: 1 
PAB Number: '?A-°B - 0 M 9 
Mailing Address: 3 0 4 C> 4 /\) cG b 
-ul ST. 
City: C.A. \J f;. c.g_ . 
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State: AZ-
Zip: _·_..8
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Phone cYeD) - S86 - 1fo19 
Email: (Y}bg\ \ej.50.z @-;JfYlO.•, \,co/l-1 
Parcel Detail 
Assessor's Parcel Number: r - s - Dh5E 
1. 
Location of Request: (ex: 3200 W. Dove Valley Road, Phoenix) 
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2. 
Description of Request: (ex: Abandon Easement bordering the South side of parcel 123-45-067A) 
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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. 
I, __________ 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: 
Signature 
Date 
Maricopa County Use Only 
Application Fee*: $1,600 
Check#: ___ _ 
Tot.al 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.