HomeMy WebLinkAboutAFFIDAVIT - 17-00753 - 157 N 2nd E - Waffle WorksCITY OF
REXBURG
Americo Family Cornmuntly
Affidavit of Legal Interest
State of Idaho
County of Madison
Name Address
City State
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
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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:
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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 c- day of 20 $
i n l
Signature
Subscribed and sworn to before me the day and year first above written.
QPAULA J. LENS
NO7ANYP( IX9STATEo1UUN
COMMISSION NO. 687212
COMM. EXP. 0240-2020
Inspection Hotline - (208) 372.2344
'Notary PU?lc of 1-dahs �
Residing at: _,3t, fq�
My commission expires: �� -
www.rexl)urg.org Permit Technician -(208)372.2341 Revised 10, 2016