HomeMy WebLinkAboutAFFIDAVIT - 20-00964 - 263 S 4th W - Lot SplitAffidavit of Legal Interest
Submit by E-mail City of Rexburg
35 North ?-East Phone: 208.359 3020
Rexburg, ID 83440 w w.rexburg.org Fax: 208.359.3022
State of Idaho
County of Madison
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Name
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Being fust duty swom 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: 1ikmm in..n+n,e..h L.0 (s%7 jZ.II:-1 th.tll b'v
N=x 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 )(o day of V CCex.&e� , 2011
Signature
Subscribed and sworn to before
me the day and year first above written.
LYNOR MENo
COMMISSION NO.IC
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SNOTAFY TATEOPUBUO
STSII N EXPIRES
MY COMMISSION IXPIPE604A1/2026
No P blic of Idaho
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Residing at:
My commission expires: