HomeMy WebLinkAboutAFFADAVIT - 17-00662 - 902 Oak Hill Way - New SFRBuilding Safety Department
City of Rexburg
35N WE Phone: 208.372.2326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3022
State of Idaho
County of Madison
Name
City
Affidavit of Legal Interest
Being first duly sworn upon oath, depose and say:
C IT Y OF
REXBURG
Anierica's F'amdy Community
S65 P61,1MC ]2d 1 0
Address
TE)
State
(If Applicant is also Owner of Record, skip to B)
That I am the recqyd owner of tlle,property described on the attached, and I grant my
permission to: Ca ll AR�%idy (t22
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 0Z7 day of 0 C 7`a 6t2 , 2017
Xy1o'�1
Subscribed and sworn to before me the day a d year first above written.��
No ry Public of Id. o
NOTARY Z Residing at: Iri(�Q �Zl ,Lj
pUBLIG �I%P'L�
• My commission expires: