Name of Property Owner *

Provide the Name of Property Owner(s)

First Name

Last Name

Name of Property Owner 2

Additional Owner Name if more than one

First Name

Last Name

Property Information *

Provide the address of the Property

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address Planning Department *

Address Where Restriction Will Be Mailed AFter Recording

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Requestor if other than Owner

Required If the party requesting the Reconveyance/Release is other than the Owner

First Name

Last Name

Phone Number of Requestor

Provide your best contact phone number

(###)

###

####