Form SURVEY "Certified Survey Affidavit" - Montana

What Is Form SURVEY?

This is a legal form that was released by the Montana Department of Revenue - a government authority operating within Montana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2014;
  • The latest edition provided by the Montana Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SURVEY by clicking the link below or browse more documents and templates provided by the Montana Department of Revenue.

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Download Form SURVEY "Certified Survey Affidavit" - Montana

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MontAnA
LCD 3
Clear Form
SURVEY
Rev 11 14
Certified Survey Affidavit
Street Address of Proposed Premises ___________________________________________________________________
City ______________________________________County _________________________________________________
In the case of a location outside the corporate boundary, include the following:
I, _____________________________________, am a
County Surveyor
City Surveyor
Private Licensed
Land Surveyor and have the knowledge and the authority to attest that the distance was measured by radial survey
method from the nearest corporate city boundary to the nearest entrance of the proposed premises known as
_______________________________(Business Name). Plat(s)/map(s) verifying the location that indicate the points
between which the measurement was made and the distance can be provided upon request.
In the case of a location inside the corporate boundary, include the following:
I, _____________________________________, am a
County Surveyor
City Surveyor
Private Licensed
Land Surveyor and have the knowledge and the authority to attest to the location of the premises known as
_______________________________ (Business Name) was determined by examination of corporate plats or other
official records.
Location of Premises (check one)
Within the incorporated boundaries of ___________________________________ (Name of City)
Less than five miles from the nearest corporate boundary of ________________________________ (Name of City)
More than five miles from any incorporated city within ___________________________________ (Name of County)
If the premises is outside an incorporated city, please provide the exact distance (in hundredths of a mile) from the nearest
corporate boundary to the nearest entrance of the premises.
.
By signing this form, I recognize state law requires the distance be measured in a straight line from the nearest entrance
of the premises proposed for licensing to the nearest corporate boundary of the city or town.
__________________________________________
_______________________________
Signature
Title
Surveyor License or Registration Number
_____________________________
Subscribed and sworn to before me this ______________day of __________________20__________.
On this________________day of____________________20__________.
Personally appeared __________________________________________
notary Seal
before me a Notary Public for the State of _________________________
____________________________________________ Notary Signature
_________________________________________ Print Name of Notary
My Commission Expires __________ Month, Day and Fourth digit of Year
MontAnA
LCD 3
Clear Form
SURVEY
Rev 11 14
Certified Survey Affidavit
Street Address of Proposed Premises ___________________________________________________________________
City ______________________________________County _________________________________________________
In the case of a location outside the corporate boundary, include the following:
I, _____________________________________, am a
County Surveyor
City Surveyor
Private Licensed
Land Surveyor and have the knowledge and the authority to attest that the distance was measured by radial survey
method from the nearest corporate city boundary to the nearest entrance of the proposed premises known as
_______________________________(Business Name). Plat(s)/map(s) verifying the location that indicate the points
between which the measurement was made and the distance can be provided upon request.
In the case of a location inside the corporate boundary, include the following:
I, _____________________________________, am a
County Surveyor
City Surveyor
Private Licensed
Land Surveyor and have the knowledge and the authority to attest to the location of the premises known as
_______________________________ (Business Name) was determined by examination of corporate plats or other
official records.
Location of Premises (check one)
Within the incorporated boundaries of ___________________________________ (Name of City)
Less than five miles from the nearest corporate boundary of ________________________________ (Name of City)
More than five miles from any incorporated city within ___________________________________ (Name of County)
If the premises is outside an incorporated city, please provide the exact distance (in hundredths of a mile) from the nearest
corporate boundary to the nearest entrance of the premises.
.
By signing this form, I recognize state law requires the distance be measured in a straight line from the nearest entrance
of the premises proposed for licensing to the nearest corporate boundary of the city or town.
__________________________________________
_______________________________
Signature
Title
Surveyor License or Registration Number
_____________________________
Subscribed and sworn to before me this ______________day of __________________20__________.
On this________________day of____________________20__________.
Personally appeared __________________________________________
notary Seal
before me a Notary Public for the State of _________________________
____________________________________________ Notary Signature
_________________________________________ Print Name of Notary
My Commission Expires __________ Month, Day and Fourth digit of Year