HomeMy WebLinkAboutAffidavit of Legal InterestInspection Hotline – (208) 372.2344 www.rexburg.org Permit Technician – (208) 372.2341 Revised 10/2016
Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440
Affidavit of Legal Interest
State of Idaho
County of Madison
I, _____________________________________________________, ___________________________________________________________________ Name Address _______________________________________________________, ___________________________________________________________________
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:__________________________ ______________________________ 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 liabilityresulting from any dispute as to the statements contained herein or as to the ownership of the propertywhich is the subject of the application.
Dated this ___________________________ day of ____________________________, 20_________
____________________________________________________________________ Signature
Subscribed and sworn to before me the day and year first above written.
_______________________________________________________________________________ Notary Public Residing at: ________________________________________________________ My commission expires: __________________________________________