Office of Housing and Community Development Property Donation

OFFICE OF HOUSING AND COMMUNITY DEVELOPMENT
Submit completed form to:
Office of Housing & Community Development
Cabinet of Economic Development
444 South Fifth Street, 5^th Floor
Louisville, KY 40202
Office: 502-574-4016

You may also submit this form via email: vapstat@louisvilleky.gov, or fax: (502) 574-4199
FOR THE DONATION OF REAL PROPERTY TO THELOUISVILLE AND JEFFERSON COUNTY LANDBANK AUTHORITY, INC.
Please read each question carefully and answer as accurately as possible. Real property cannot be donated to the Landbank Authority if occupied either legally or illegally or used by any person or persons.
PROPERTY INFORMATION:
PROPERTY ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parcel ID # (if known)
Is the property a vacant lot or does it have a structure?
OWNER INFORMATION:
FULL NAME:

First NameMiddle InitialLast Name
ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PHONE NUMBER:
Format: (000) 000-0000.
EMAIL ADDRESS:
example@example.com
1. Property Owner's Marital Status:
2. If the Property Owner is "Married", please provide Spouse's full name:

First NameLast Name
3. If the owner is deceased, please attach a copy of the owner's Last Will and Testament or a list of heirs who may have inherited the property from the owner.

APPLICANT INFORMATION:
FULL NAME:

First NameMiddle InitialLast Name
ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PHONE NUMBER:
Format: (000) 000-0000.
ALTERNATE PHONE NUMBER:
Format: (000) 000-0000.
EMAIL ADDRESS:
example@example.com
Note: If you are not the Property Owner, please attach proof that you have legal authority to represent them.
DONATION INFORMATION:
1. Are you aware of any debts, liens, sold property taxes, contracts, lawsuits, governmental administrative actions, or other circumstances that might cloud title to this property or prevent you from conveying a clear, unencumbered title with covenant of general warranty?
If "YES", please give details in the space provided below:
2. Why do you want to donate property to the Landbank Authority? Check all that apply.
3. Is there any other information that might be helpful to complete the donation of this parcel to Metro Louisville and its Landbank Authority? Please give details in the space provided below.
APPLICANT'S SIGNATURE:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

OFFICE OF HOUSING AND COMMUNITY DEVELOPMENT