HomeMy WebLinkAboutAFFIDAVIT - 16-00279 - The Cottages Bldg 2CITY OF
REXBURG
Ameticas rgmily Community
Affidavit of Legal Interest
State of Idaho
County o Madison
I, Ccv/ � /tet U�2c�G�
Name
/�f
City
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
2 6 a 66.j 3s'Oo 41
Address
State
A. That I am thearecord owner of the property de ribed on the attached, and I grant my permission too:
/'� ��O�Ier ra�v� ��L��y C��IST
Name f Address
to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any claim or liability
resulting from any dispute as to the statements contained herein or as to the ownership of the property
which is the subject of the application.
Dated this 7 day of 201L
Signature
Subscribed and sworn to before me the day and year first above written.
,PAgp
AUBIIP
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Residing at: I i `Odsgn GU n4y , iA l d
My commission expires: 10 / (,i // i
Inspection Hotline -(208)372.2344 w .rexhorg.org Permit Technician -(208)372,2341 Revised March, 2016