Do I need a notary for the reimbursement statement?

No. The statement has signature and date fields for the applicant and owner, with no notary block or sworn attachment.

What does signing this statement mean?

The signers agree to reimburse the Town for professional and consulting fees related to applications, even if an application is not approved or successful.

How do I submit the reimbursement statement?

The form lists the Planning & Building Department at 85 East Main Street, Victor, NY 14564, and codes@townofvictorny.gov. Check the city website for current contact details.

Victor, NY · Ontario County

No notary required

Statement of Applicant and Owner With Respect to Reimbursement of Professional and Consulting Fees

This statement records an applicant’s and owner’s agreement to reimburse the Town of Victor for professional and consulting fees related to their application.

At a glance

Issued by: City of Victor · Victor, Ontario County, New York
Notarization: Not required: file this form without a notary.
Official source: townofvictorny.gov
Blank form: Download the PDF
Catalogued: Sep 28, 2026
Machine-readable: JSON record · about the forms index

What this form is

Applicants and owners complete this statement in conjunction with an application to the Town of Victor. It confirms their agreement to reimburse the Town for professional and consulting fees, including engineering or legal fees, regardless of whether the application succeeds. The statement also describes potential collection costs and says each application party is jointly and severally liable for fees and expenses.

Who needs it

Applicants and owners applying to the Town of Victor who are asked to acknowledge responsibility for professional and consulting fees should complete this statement.

How to submit it

The form lists the Planning & Building Department at 85 East Main Street, Victor, NY 14564, and [email protected]. It also lists phone and fax numbers.

About notarization

This document is signed and dated without a notary; it contains no notarized or sworn attachment, so the applicant and owner just sign and date it.

How to submit this form

1
Download the Statement
Download the Town of Victor statement of applicant and owner with respect to reimbursement of professional and consulting fees.
2
Complete the Statement
Review the reimbursement terms and fill in the applicant and owner signature, title, and date fields.
3
Gather Application Materials
Complete any other materials required for your application; this statement does not list specific attachments.
4
Submit to the Town
Use the Planning & Building Department address or email listed on the form to contact the Town about submission.

Frequently asked questions

Do I need a notary for the reimbursement statement?: No. The statement has signature and date fields for the applicant and owner, with no notary block or sworn attachment.
Who completes the professional fees reimbursement statement?: The statement is for the applicant and owner in conjunction with an application to the Town of Victor. It provides signature, title, and date fields for both.
What does signing this statement mean?: The signers agree to reimburse the Town for professional and consulting fees related to applications, even if an application is not approved or successful.
How do I submit the reimbursement statement?: The form lists the Planning & Building Department at 85 East Main Street, Victor, NY 14564, and [email protected]. Check the city website for current contact details.

Need something notarized?

This Statement of Applicant and Owner With Respect to Reimbursement of Professional and Consulting Fees doesn’t need a notary, but if you have another Victor form that does, a commissioned online notary can help.