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Surplus County Land

Purchase Form

Name
Online Username
Address
City
State	AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code
E-mail Address
Phone Number
State ID #
County parcel is in
Street Parcel is on
Lot #
Parcel ID #
I acknowledge that:
I do I do not own other property in this county (used to determine eligibility).
I am currently up to date on my taxes and association fees on all other parcels I own.
I currently own property within the same association where the reference parcel is located and desire a discount.
I currently own property that is immediately adjacent to the reference parcel and desire a discount.
I agree to pay the full amount due within 5 business days of being confirmed as an eligible purchaser.