HomeMy WebLinkAboutAFFIDAVIT - 17-00236 - 486 S 3rd W - The Roost - CUPAffidavit of Legal Interest
City of Rexburg
35 North Is' East Phone: 208.359.3020
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3022
State of Idaho
County of Madison
i, lav L L(
Name
MOV
City
Address
Zi- %--
State
REX.B.I.T.- RGY
................ {, ..................
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: 11-k, hoc Q to S -3 4z/ G��
Name 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 day of lWam 20
Signature
Subscribed and sworn to before me the day and-uaZirst above written.
HEATHER LEA ERICKSON
Notary Public
State of Idaho
Notak Pudic of I
Rf sidin Rdasidinn in
Idaho Falls, ID
My commission expire- S
6-11-2019