Village of Sag Harbor
Waiting List Application
P.O. Box 660 · 55 Main Street · Sag Harbor, NY · 11963
Phone: 631-725-0222 · Fax: 631-725-0316
2021 WAITING LIST APPLICATION
NAME_______________________________________________________ HOME PHONE #______________________________________
HOME ADDRESS_____________________________________________ CELL #_______________________________________________
_____________________________________________ EMAIL_______________________________________________
WINTER MAILING ADDRESS________________________________________________________________________________________
________________________________________________________________________________________
EMERGENCY CONTACT NAME________________________________ PHONE #____________________________________________
BOAT YEAR/MAKE/MODEL_________________________________________________________________________________________
LENGTH____________________________ BEAM______________________________ DRAFT__________________________________
TYPE: POWER ( ) SAIL ( ) REGISTRATION/DOCUMENT# (SUMBIT COPY) ___________________________________________
COLOR___________________ TRIM COLOR_________________NAME OF BOAT____________________________________________
OTHER DESCRIPTIVE INFORMATION________________________________________________________________________________
__________________________________________________________________________________________________________________
MOORING ( ) DINGHY ( ) CABLE ( ) A-DOCK ( ) B-DOCK ( ) MARINE PARK ( ) BAY ST. ( )
TO QUALIFY FOR RESIDENTIAL STATUS, YOU MUST BE A VILLAGE TAXPAYER OR HOLD A CURRENT ANNUAL
LEASE WITHIN THE CONFINES OF THE INCORPORATED VILLAGE OF SAG HARBOR ONLY. PLEASE SUBMIT A
COPY OF A VILLAGE TAX RECEIPT OR LEASE.
RESIDENT ( ) NON-RESIDENT ( ) COMMERCIAL ( )
DATE_______________________________ SIGNATURE________________________________________________________________
TO BE PLACED ON THE WAITING LIST, MAIL COMPLETED APPLICATION TO THE ABOVE REFERENCED ADDRESS.
AN APPLICATION CAN ALSO BE EMAILED TO ACCOUNTCLERK@SAGHARBORNY.GOV
DATE RECEIVED_____________________ STATUS_____________________________________________________________________