HomeMy WebLinkAboutAFFIDAVIT - 16-00293 - Rigby Eye CareCITY OF
REXBURG
CW
Ameriw! Family Community
Building Safety Department
Submit ey Email City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
Affidavit of Legal Interest
State of Idaho
County of Madison f
l� 5a7 �G�l�s C�Ke �Jr S�-e
Name Address
Ptcfk �_/ 1 �
City State
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
A. That I am the record owner of the property described on the attached, and I grant my permission to:
The HighPointe Companies 217 West 2nd South, Rigby
Name Address
to submit the accompanying application pertaining to that property.
B. 1 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 day of f 20
Subscribed and sworn to
•,%puu,„g0,
:,�:• OT ARy•��2�%
O
Jar •. ,••� `c
,,,��''•.q�TE OF ��•,•�',•
Inspection Hotline - (208) 372.2344
the day and year first above written.
Notary Public of I0gO
Residing at:
My commission expires:
w ..rezburg.org Permit Technician -(208)372.2341 Revised March, 2016