HomeMy WebLinkAboutAFFIDAVIT 2 - Brook Lauren Foundation - 21-00150 - RP06N40E164201 - Impact Area Lot Line Adjustment (1)Affidavit of Legal Interest
City of Rexburg
35 North IS' East Phone: 208.359.3020
Rexburg, /D 83440 www.rexburg.org Fax: 208.359.3022
State of Idaho
County of Madison
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Name
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City
Being first duly sworn upon oath, depose and say:
CITY OF
REXBURG
America's Family C;vrrauwwnify
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Address
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State
(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.
W.
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.
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Dated this
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Subscribed and sworn to before me the day and year first above written.
Y ' T
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LYNDA 1rtEPSRILL Y blit of Idaho
COMMISSION OTRY PUBLIC 875
STATE OF IDAHO
MY COMMISSION EXPIRES 04/04/2026 Reslding at: lY ��
My commission expires: