HomeMy WebLinkAboutAFFIDAVIT - 22-00034 - Nitro Car Wash
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 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 _______________________, 20_________
_________________________________________________
Signature
Subscribed and sworn to before me the day and year first above written.
_______________________________________________ Notary Public of Idaho
Residing at: _______________________________
My commission expires: _____________________
35 North 1st East Rexburg, ID 83440 Phone: 208.359.3020 Fax: 208.359.3022
www.rexburg.org
Affidavit of Legal Interest
City of Rexburg