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2. The undersigned, being the owner or owners of the real estate located in the City of Brownwood, Texas, described as follows:
4. First Name
5. Last Name
7. Legal Description
9. Property Tax Number
11. Owner Acknowledgement
    Hereby recognize that there is situated on such real estate a nuisance, to wit: (substandard structure; stagnant water in swimming pool, junked vehicle), as that term is defined by applicable ordinances of the City of Brownwood, Texas, and hereby request that the City of Brownwood abate such nuisance by (demolishing the structure and cleaning and grading surface). I understand that I am entitled to a public hearing wherein I may present proof of compliance with City ordinances. By my signature below I hereby waive my right to the public hearing and admit that the (structure, swimming pool, junked vehicle) constitutes a nuisance and constitutes a danger to the public health, safety and welfare.
13. Liability Release
    And in consideration therefore, I/we hereby release the City of Brownwood, its agents, servants, representatives, officials, officers and employees from any and all liability that arises or may arise from the abatement of the nuisance, including (any damage to other structure, vegetation, trees; any damage resulting from the pool floating out of the ground due to hydrostatic pressure).
15. City of Brownwood
    The City of Brownwood agrees to abate the nuisance (demolishing the structure, cleaning and grading the surface; by draining all water from the pool.)
    
    It is further agreed that the City shall have a lien on the above referenced property to recoup the total cost of the abatement, including any administrative charges and any other charges incurred by the City in abating the nuisance.
17. Date
    Date
18. Owner Signature
20. Address
22. City
23. State
24. Zip
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26. 1. Receive an email copy of this form.
27. Email address

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28. Submit

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