Form Center

Agent Authorization Form

2. 
4. Email
6. Application Title
8. Tax Map Number(s)
10. The above named property owner hereby appoints:
    as its agent, and authorizes said agent to apply for and process the above mentioned development plan on his/her behalf. Agent is further authorized to sign all necessary documentation for such purposes, including acceptance of conditions imposed by Council upon approval of the plan. This authorization shall remain in force and effect until written notice of revocation is delivered to the Municipality of Murrysville’s Director of Community Development.
12. Signed and sealed, intending to be legally bound on this date of:
14. Print Name
16. By checking "Yes," you are electronically signing this document.*

    1. Yes
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field