HomeMy WebLinkAboutAFFIDAVIT - Sean Hayden - 21-00995 - Lot Line Adjustment - Evergreen Blk3 Lot 11 & Starlite Add. Blk 1 Lot 2Affidavit of Legal Interest
35 North 1•1 East
Rexburg, ID 83440 www.rexburg.org
State oflaaho C)rf!50/J
County of Madisoa• M l1 I /no!Yla.A
I, seM Ha,den
Name
City
City of Rexburg
Phone: 208.359.3020
Fax: 208.359.3022
Address
State
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
C" l TY OF
REXBURG
A.That I am the record ow _ner of the property described on the attached, and T grant my
permission to: ____________ _
Name r\ddress
to submit the accompanying application pertaining to that property.
B.I agree to indemnify, defend and hold Rexburg City and its employees harmless from anyclaim or liability resulting from any dispute as to the statements contained herein or as to theownership of the property which is the subject of the application.
Id J · � �ff ·qft... ;L-Dated this , , '¥ c{)Z.. I day of �01 va-_!'.;:(
Subscribed and sworn to before me the day and yeat first above written.
ifiJtary Public ofJ41.ht, CJr�c't)
, 20az.
OFFICIAL STAMP MICHELE SMITH NOTARY PUBLIC -OREGON
COMMISSION NO. 984144
MY COMMISSION EXPIRES FEBRUARY 18, 2023 Residing at: C7r.1Jchatn,, 0 r (Jcl a
My commission expires: {;,,k,m Ce..Y?j Jg/, 2():),3
Terry Hansen 1331 Fremont Ave. Idaho Falls, ID 83402