HomeMy WebLinkAboutAFFIDAVIT 3 - 21-00150 - Calvin Kinghorn - RP06N40E164201 - Impact Area Lot Line Adjustment (1)Submit by E-mail
35 North Ist East
Rexburg, ID 83440
Affidavit of Legal Interest
State of Idaho
County of Madison
Name
O YA i a
city
City of Rexburg
Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3022
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Address
State
— CZ TY SOF
.EXBURG
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Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to S)
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 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 k , 24
Signature.
Subscribed and sworn to before me the day and year first above written.
R'UI T H ANN' HATCH u Public of Idaho
NOTARY PUBi IC - STATE OF IDAHO
COMMISSION NUMBER 19599
MY COMMISSION ExPRES 10-14-2022
Residing at
My commission expires: -�-�