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Revised 1/30/2015 Cayuga County, State of New York Survey Map Affidavit For filing Survey Maps at the Cayuga County Clerk’s Office: 1 mylar & 2 paper maps required. MUST BE ORIGINALS. Min 8 ½” x 11” Max 34” x 44” Title of Survey Map Property owner’s name at time of Tax Map Involved_________ Town/Village or City Name of Date of 1. Does this survey map divide an existing parcel? If NO, continue to #4 2. Is local subdivision approval required? (See Summary of Subdivision Regulation) If YES, name of Planning Board Official that signed map: of 3. Does the map create 5 or more lots that are 5 acres or less? If YES, Health Department approval is required prior to filing map at Clerk’s Office. 4. Does this map amend or correct a map already on file If YES, map number required To the best of my knowledge the above information is correct. I hereby represent that if this map divides an existing parcel, I have consulted with the town, city, or village clerk and I state that all approvals required by law have been complied with and that the approvals are noted on the survey map. Notice: In a written statement filed with the County, any person who knowingly makes a false statement which such person does not believe to be true has committed a crime under the laws of New York State punishable as a Class A Misdemeanor (PL Sec. 210.45). Sworn to me this day Signature of filer Name of Notary Public Clerk’ Use Only: Map Number