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2. Organization Requesting Demolition
   -- Select One --BartonFrostburgLonaconingLukeMidlandWesternportOther
4. If "Other", please identify your organization:
6. Name of Individual Reporting:
8. Contact Telephone Number:
9. Contact Email Address:
11. Does the requesting organization have clear title to the real estate or real property?

    1. Yes

    1. No
13. If YES, The property is titled to:
15. Are there any restrictions, limited easements, or third party permissions required?

    1. Yes

    1. No
17. If YES, please explain:
19. Physical Address of Property:
21. City:
22. Tax Account ID:
24. Additional Helpful Information:
26. Photo or File Upload
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field