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Land Bank Side Lot Marketing Form

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4. Notice
   Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.
6. Land Bank Side Lot Marketing Form
   Interested in buying land from the Berrien County Land Bank? Complete this form.
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10. First Name*
11. Street Address*
13. Last Name*
14. City*
16. Phone Number*
17. State*
18. Zip Code*
20. Address of location of adjacent parcel or interest*
22. Reason for your side lot interest: *

    1. Expansion of Yard
    2. Community Garden
    3. Other

    If Other, please provide a short explanation below
23. Do you own, rent, or occupy the above address?*

    1. Own
    2. Rent
    3. Occupy
24. What is your property tax status?*

    1. Current
    2. Behind
26. Other:
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30. Contact Information
    For more information or questions, please contact Katie Montoya at the Berrien County Land Bank.
    (269) 983-7111 ext. 8257
    Fax: (269) 982-8611
    cmontoya@berriencounty.org
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34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field