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35 North 1s, East
Rexburg, ID 83440
State of Idaho
Affidavit of lega I Interest
City of Rexburg
County of Madison
I, k
Name
City, >
Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3022
Being first duly sworn upon oath, depose and say:
Address
State
(If Applicant is also Owner of Record, skip to B)
E BURG
A. That I am the record owner of the property described on the attached, and I grant my
permission to: Kenyon Crouch of Sign Pro 2274 W Heritage Cir., Idaho Falls, ID 83402
Name \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 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 .'Tu v day of , 20
Sigture
Subscribed and sworn to before me the day and year first above written.
of Idaho
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pUBV �o ; � l�'Iy commission expires: ZO Z �
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