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2. 
4. First Name*
5. Last Name*
7. Mailing Address*
8. City*
9. State*
10. Zip Code*
12. Phone with area code*
13. Email Address*
15. Property Address*
16. Zip*
18. Do you own the property?*

    1. Yes
    2. No
19. How long have you owned it?*
21. Do you have a contract for purchase?*

    1. Yes
    2. No
22. When do you intend to purchase?*
    When do you intend to purchase?
24. What is the historical ownership and passed uses of the property?*
26. What are your proposed plans for the property?*
28. Estimated redevelopment cost?*
29. Estimated number of new jobs to be created?*
31. List any other community benefit you anticipate occurring because of your project.*
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33. 1. Receive an email copy of this form.
34. Email address

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35. Submit

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