HomeMy WebLinkAboutAFFIDAVIT - 22-00199 - Hepworth - W 3rd N - Lot Line AdjustmentAffidavit of Legal Interest
City of Rexburg
35 North 10 East Phone: 208.359.3020
Rexburg, 0 83440 www.rexburg.org Fax: 208.359.3022
State of Idaho
County of Madison
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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 m
permission to: ,/ Z`t QjT
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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 � TN day of 41 4 -d -C f-/ , 20 Z ?—
Signature Signature
Subscribed and sworn to before me the day and year First above written.
Darin M Herzoff Notary Public of Idaho
Notary Public
State of Idaho Residing at: '2FXf3u(L(-i T�
Commission No. 55282
My commission expires: / 0 2OZ 7