(All information in red is required in order for your request to be considered.)

Applicant Contact Information:

Legal Name

and/or Name of Legal Entity

Mailing Address 

City, State, Postal Code and Country (if other than USA)

Area Code and Telephone Number

Area Code and Facsimile Number, if applicable

E-mail Address, if available

County property of Interest:

Abbreviated Legal Description of Property:

STRAP (Tax Identification) Number:

Site Address:

Intended future use of property, if acquired. 
(If you require additional space, please identify any attachments as Exhibit #1, 2, etc., and send attachments to the Division of County Lands Director as indicated in one the two remaining transmittal methods.)
Additional pages are required to be attached to this request, if box is checked.

Real Estate Broker Contact Information (if applicable):   If not applicable, please check this box

Additional Comments/Message:

PLEASE READ and ACKNOWLEDGE

By submitting this form to Lee County Government, Division of County Lands, I/We acknowledge I am/We are ready, willing and able to purchase the property herein described, should it be declared surplus and I am/We are, in turn, the successful bidder of said property.

      I/We have read, understand and agree to the above statement.
(You must acknowledge the above by checking the box in order to proceed.)