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2. OWNERS
3. APPLICANT (if other than owner)
5. First Name
6. First Name
8. Last Name
9. Last Name
11. Address
12. Address
14. City
15. City
17. State
18. Zip Code
19. State
20. Zip Code
22. Phone Number*
23. Phone Number
25. Deeds:

    1. Copy of the deeds of the original properties to be split 

    2. New deeds to be filed which reflect the new properties created

27. Plat and information provided by a surveyor certified by the State of Oklahoma, signed and sealed:

    1. Written and boundary description of the original lots
    2. Written and boundary description of the proposed lots
    3. Boundary description will include:

    •   Area
    •   Names and dimensions of all existing streets, alleys and utility easements bordering, abutting or within the proposed split 
    •  Date 
    •  Map Scale 
    •  North Arrow
    •   Location of all bodies of water, watercourses, structures and other physical features
    •   Dimensions in feet and hundredth parts thereof 
    •  Bearing and curve data for all lots, blocks and street lines
    •   Building setback lines
29. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
31. Electronic Signature
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field