Fort Ann, NY · Washington County
GML §239-M Referral Form
Municipalities use this form to refer qualifying proposed land-use actions to the Washington County Planning Board for review.
What this form is
This form records a proposed action and the municipality, applicant, site, land-use conditions, and referring body. The municipality identifies the action and whether the location is within 500 feet of listed boundaries or features, then includes the required supporting materials. The form also provides contact details, a certification to sign and date, and spaces for Planning Department receipt information.
Who needs it
A municipal person responsible for submitting a qualifying proposed land-use action to the Washington County Planning Board completes this form.
How to submit it
Include twelve printed copies of the completed package and provide an electronic version by CD or email to Washington County Real Property. The form does not give a mailing address or email address.
About notarization
This document is signed and dated without a notary; it lists no attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download the Form
Download the GML §239-M Referral Form for the proposed municipal land-use action.
- 2
Complete the Form
Enter the project, applicant, site, proposed action, referring body, and responsible submitter information; sign and date the receipt certification.
- 3
Gather Supporting Materials
Include the applicable EAF, ordinance or local law text, application, maps and plans, and aerial photographs listed on the form.
- 4
Prepare Copies and Submit
Prepare twelve printed copies and an electronic version by CD or email to Washington County Real Property.
Frequently asked questions
- What is the GML §239-M Referral Form used for?
- Municipalities use it to submit information about a proposed land-use action and supporting materials to the Washington County Planning Board.
- Who completes this referral form?
- The form requests information about the person responsible for submitting the referral, including their title or position and contact details.
- Do I need a notary for the GML §239-M Referral Form?
- No. The document is signed and dated without a notary, and it lists no attachment or related step that must be notarized or sworn.
- How do I submit the GML §239-M Referral Form?
- The form calls for twelve printed copies of the completed package and an electronic version provided by CD or email to Washington County Real Property.
Need something notarized?
This GML §239-M Referral Form doesn’t need a notary — but if you have another Fort Ann form that does, a commissioned online notary can help.