Fill and Sign the Aamu Medical Form

Commonwealth of Virginia MARINE RESOURCES COMMISSION For VMRC Use Only: Date:____________________________________ District No. __________ 2600 Washington Ave., 3rd Floor Newport News, VA 23607 Transfer No: _____________________________ Revised 7-6-2011 APPLICATION FOR TRANSFER OF OYSTER PLANTING GROUND From: _______________ To: _______________ Please see instructions on reverse side of this sheet Lease(s) in the name(s) of ______________________________________________________________________________________________________________________________ To be completed by VMRC I/We, _________________________________________________________________________________________________________________________________________________ Name(s) of Transferor(s) Pursuant to the Code of Virginia and subject to the approval of the Chief, Engineering/Surveying, transfer To:___________________________________________________________________________________________________________________________________________________ Address:_____________________________________________________________________________________________________________________________________________ Name and Address of Responsible Contact (if more than one lessee):__________________________________________________________________________________________ Telephone: ___________________________________ ____________________________________ Home Work the oyster planting ground lease(s) located in __________________________________________________ __________________________________________________________ Creek/River Acreage Plat File No. Described: Acreage Plat File No. City/County Acreage Plat File No. (1) __________ __________ (3) __________ __________ (5) __________ __________ (7)_________ _________ (2) __________ __________ (4) __________ __________ (6) __________ __________ (8)_________ _________ Check Appropriate Authorization for your Signature: If Responsible Contact Address Changed, All Leaseholders Must Sign. _____ Lessee(s) _____ Power of Attorney __________________________________________________________________________________________ _____ Executor _____ Executrix _____ Administrator _____ Administratrix _____ All Heirs Is Lessee Deceased? Yes __________ No __________ Signature Date __________________________________________________________________________________________ Signature Date __________________________________________________________________________________________ Signature Date Provide Date of Death: ____________________________ I, ____________________________________________________ certify that ________________________________________________________________________ signed the above. (Notary Public or Marine Patrol Officer) ________________________________________ City/County __________ _____________________ ________________________________________________ _______________________ State Commission Expires Signature (Notary or MPO) Date FOR VMRC USE ONLY I hereby approve the above transfer to be effective on _______________________________________________, 20 _______. ___________________________________________________________________________________ Chief, Engineering/Surveying and Oyster Ground Leasing Lease No. From Acreage Plat File No. Waterbody Code Map No. New Lease No. ALL RENT MUST BE PAID BEFORE THE TRANSFER IS APPROVED. THE APPLICATION FOR TRANSFER FEE IS: $5.00 FOR TEN (10) ACRES OR LESS $10.00 FOR MORE THAN TEN (10) ACRES FEE NON-REFUNDABLE FEE NON-REFUNDABLE AFTER THE TRANSFER IS APPROVED, YOU WILL RECEIVE A BILL FOR THE RECORDING AND ASSIGNMENT FEES. RECORDING FEE: $12.00 FOR EACH PARCEL ASSIGNMENT FEE: $1.50 FOR EACH PARCEL The transfer process can be speeded up if the recording and assignment fees are included with this form; be sure to include recording and assignment fees for each parcel. NO TRANSFER WILL BE COMPLETED UNTIL ALL FEES HAVE BEEN PAID. MAKE CHECKS PAYABLE TO "TREASURER OF VA". ALL LEASEHOLDERS TRANSFERRING OYSTER GROUND MUST SIGN THIS TRANSFER. IF THE RESPONSIBLE CONTACT ADDRESS IS CHANGED, ALL LEASEHOLDERS MUST SIGN. IF THE POWER OF ATTORNEY SIGNS, SUBMIT A COPY OF THE DOCUMENTATION. IF THE LEASEHOLDER IS DECEASED, ONE OF THE FOLLOWING MUST BE CHECKED ON THE FRONT TO DENOTE YOUR AUTHORIZATION TO SIGN: EXECUTOR/EXECUTRIX(S) ADMINISTRATOR/ADMINISTRATRIX(S) HEIRS OF THE ESTATE (ALL HEIRS OF THE ESTATE MUST SIGN) IF THE LEASEHOLDER DIED WITHOUT A WILL, THE SURVIVING SPOUSE MAY HAVE THE AUTHORITY TO SIGN THE TRANSFER, UNLESS THERE ARE CHILDREN FROM A PREVIOUS MARRIAGE. IF YOU HAVE FURTHER QUESTIONS, CALL 757/247-2226. Lease No. From Acreage Plat File No. Waterbody Code Map No. New Lease No.