HomeMy WebLinkAboutAFFIDAVIT - Erikson Robert Family LMT PRT - Erikson 40 Acres - 1040 W Main - Lot Line AdjustmentAffidavit of Legal Interest
City of Rexburg
35 North N East Phone: 208.359.3020
Rexburg, !D 83440 www.rexburg.org Fox: 208.359.3022
State of Idaho
County of Madison
I,Q obtr+ ENCQoYI f4m;(y Lxfr� Perfoer5V
Name
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City
Being first duly sworn upon oath, depose and say:
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Address
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State
(If Applicant is also Owner of Record, skip to B)
CITY OF
REURG
Anx iwl amily Community
A. That I am the record owner of the property described on the attached, �and I ant my
permission to: b V\ _! �Ty�Gr1-INS _ 7�7 �tTy—�. V�
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.
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Dated this
Signature
day of . 20_.__ _
Subscribed and sworn to before me the day and year first above written.
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