HomeMy WebLinkAboutAFFIDAVIT OF LEGAL INTEREST - 20-00928 - 165 N 1st W - Rezone to HDR1Submit by E-mail
35 North 10 East
Rexburg, ID 83440
Affidavit of legal Interest
City of Rexburg
State of Idaho
County of Madison
Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3022
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Name
jZ X'bur
City
C I T Y o f
REXBURG
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A,n,,k4 Family Community
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Address
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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 o the attached, and I grant my
permission to: W1, k 0- r o a Pr o 12 e V- ci eS
Name Address r
to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and hold Rexburg City and its employees harniless 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 be 20 -2,G
Signature
Subscribed and sworn to before me the day and year first above written.
ry public of Idaho
p(ARYaw Residing at: QG�!/11TLtJ
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p B�`^' Z .' My commission expires: W 22' 2,b Z �j
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