Ky. Rev. Stat. Ann. § 100.3683 – Form of certificate.

The form for the certificate of land use restriction required by KRS 100.3681 shall be as follows:

CERTIFICATE OF LAND USE RESTRICTION

1. NAME AND ADDRESS OF PROPERTY OWNER(s) ................................................. ................................................. ................................................. 2. ADDRESS OF PROPERTY

............................................................................. ............................................................................. ............................................................................. 3. NAME OF SUBDIVISION OR

DEVELOPMENT (if applicable)

................................................. ................................................. ................................................. 4. .......Zoning Map Amendment to Zone .......Development Plan

TYPE OF RESTRICTION(s) (Check all that apply):

.....Conditional Zoning Condition .....Other ..................................................... specify

.......Unrecorded Subdivision Plat .......Variance .......Conditional Use Permit 5. NAME AND ADDRESS OF PLANNING COMMISSION, BOARD OF ADJUSTMENT, LEGISLATIVE BODY OR FISCAL COURT WHICH MAINTAINS THE ORIGINAL RECORDS CONTAINING THE RESTRICTION

.................................................. .................................................. .................................................. .................................................. ..................................................

.............................................................. Signature of Completing Official .............................................................. Name and Title of Completing Official (Type or print)

Effective: July 1990

History: Amended 1990 Ky. Acts ch. 362, sec. 8, effective July 13, 1990. -- Created 1988 Ky. Acts ch. 30, sec. 4, effective July 15, 1988.