I affirm that I am the owner of the property described in this application and that I am familiar with the prerequisites of Section 54.1-1111 of the Code of Virginia and I am not subject to licensure as a contractor or subcontractor. I am also aware that this is a violation of State Law to hire or award a contract to an unlicensed contractor.
This portion of the form must be notarized. You may submit the form as is to Appomattox County and then stop by during business hours (8:00 a.m.-4:30 p.m. Monday-Friday) at 153 A Morton Lane Appomattox, VA to have it printed and notarized. You may also print the PDF version of this form and have it notarized then drop it by the County Administration building in the Drop Box or at the front desk during business hours.