OFFICE OF

PLANNING BOARD

Town Of Belchertown

P.O. Box 964

Belchertown, Massachusetts 01007

FORM F

APPLICATION FOR PARTIAL RELEASE AND/OR

EXCHANGE OF PERFORMANCE GUARANTEES OR COVENANTS

, 20

This agreement between the subdivider, or applicant, and the Town of Belchertown is bound by the following terms, the Belchertown subdivision regulations, §270-32, and MGL c. 41, §81U.

Applicant:

Address of applicant:

Name of subdivision:

Designed by:

Address of designer:

On land owned by: Address of owner 1:

Address of owner 2:

Address of owner 3:

Definitive plan endorsed by the Planning Board on , 20

Definitive subdivision plan recorded in the Hampshire Registry of Deeds,

Book , Page

Existing performance agreement on this subdivision: (Check and fill in)

___ Surety Bond # $ ___________

___ Savings Passbook # $ ___________

Lender’s Agreement

Bank $ ___________

Covenants

Document # $ ___________

Other Certificate # $ ___________

TOTAL AMOUNT $ ___________

Desired performance agreement on this subdivision: (Check and fill in)

___ Surety Bond # $ ___________

___ Savings Passbook # $ ___________

Lender’s Agreement

Bank $ ___________

Covenants

Document # $ ___________

Other Certificate # $ ___________

TOTAL AMOUNT $ ___________

This application is a request to:

_______ Reduce the existing performance guarantee

Amount proposed $ ___________________ (submit inspection form and

engineering cost estimate)

X Release covenants

List lots to be released

X Exchange one performance guarantee for another

Preferred form

Amount $ (submit inspection form and engineering cost estimate)

The undersigned submits the accompanying performance guarantee in exchange for release or reduction of the current performance guarantee. The undersigned hereby covenants and agrees with the Town of Belchertown upon acceptance of the new performance guarantee:

1. To construct ways and install the municipal securities as finally approved by the Planning Board, and in strict compliance with the Subdivision Rules and Regulations of the Town of Belchertown.

2. To file any change of performance guarantee and/or status of covenanted lots in said subdivision with the Hampshire Registry of Deeds and notify the Belchertown Planning Board with certification (book and page numbers) of this filing.

___________________________________

Signature of Applicant

___________________________________

Signature of Owner (if other than applicant)

In so far as the requirements of the Planning Board are concerned, the release of lots from covenant or exchange of performance guarantee is:

Approved _______ Disapproved _______

Chair

Signatures of a majority of the Planning Board

of the Town of Belchertown

A True Copy Attest: _____________________________

Clerk of the Planning Board

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Planning Board Fee:

Cost $ Planning Department Signature: ___________________________

Received by Town Clerk:

Date: Time:

Amount Received:

Town Clerk's Signature:

Copies:

Applicant

Town Clerk

File