Please read carefully:

Under the mandatory provisions of Va. Code Ann. § 15.2-852, each member of the Board of Supervisors, Planning Commission, and the Board of Zoning Appeals must make a full public disclosure of any business or financial relationship that the member has or has had with the applicant, title owner, contract purchaser, or lessee of the land or their agent within twelve months prior to a public hearing. These provisions are applicable only to Fairfax County. The definition of a business or financial relationship in Va. Code Ann. § 15.2-852 has been amended to include "any gift or donation having a value of more than $100, singularly or in the aggregate."

The Fairfax County Board of Supervisors and Planning Commission have adopted land use affidavit forms to be used with rezoning, special exception, special permit, and variance applications, and reaffirmation procedures for affidavits. The adopted "Affidavit" and "Reaffirmation of Affidavit" forms shall not be altered or modified in any way. Any form that is altered or modified in any way will not be accepted.

With the submission of any zoning application, you are required to submit an Affidavit. Prior to a public hearing, you will be required to reaffirm your Affidavit in accordance with the adopted reaffirmation procedures.

Affidavit and Reaffirmation of Affidavit forms are available below in Portable Document Format (PDF). To view or print these forms, Adobe Reader, must be installed on your computer. These forms can be downloaded to your computer, filled in offline, and printed. (Using the fill-in feature is optional.)

Please Note: Adobe Reader will NOT allow you to save your changes. Any information you enter into the form fields will be lost when the PDF file is closed. If you have the complete version of Acrobat installed on your computer, your changes may be saved for later use.

Disclaimer: The fill-in feature included in the Affidavit PDFs is provided for your convenience. We cannot guarantee that these PDF documents will function as expected on ALL computer systems. The Department of Planning and Zoning does not provide technical assistance for Adobe Acrobat or Adobe Reader. If you have trouble with functionality or printing the Affidavits, you may find the Acrobat support page of the Adobe Web site helpful. Affidavits can be printed and filled in by hand or typewriter if you are unable to take advantage of the fill-in feature.

Please select the appropriate form for your application from the list below. If you are unsure which form you need, please call the Department of Planning and Zoning at 703-324-1290, TTY 711 (Virginia Relay).

Download Instructions
Click a PDF document to open. Once opened in your browser window, click Save on your Adobe toolbar. In the "Save a copy" window, navigate to the file folder on your PC where you wish to save the file. (Be sure to note which folder you saved to, so that you can easily retrieve the file from your PC.) Click Save.

Navigation
To navigate these forms, use the mouse and/or tab key. Tabbing will move the cursor to the next field; shift+tab will take the cursor back one field.

Filling in Form Fields
If you have trouble typing into the form, please be sure your "Select Text Tool" on the Adobe toolbar (not your browser tool bar) is depressed.

Troubleshooting Affidavit Forms