HomeMy WebLinkAboutAFFIDAVIT - 22-00499 - 331 Cul De Sac Dr - Patio CoverAffidavit of Legal Interest
State of Idaho
County of Madison I ,-
Name
-ke
Clicy�-
Being first duly sworn upon oath, depose and say.
(If Applicant is also Osmer of Record, skip to B)
Building Safety Department
City of Rexburg
35 North 1.1 East
Rcxbu% Idaho 83440
-
Addimn
SpA N n P�34�-ICS
state
A. That I am the record owner of the property described on the attached, and I grant my permission to:
MIADEWORNS 12443 W EXECUTIVE DR
WISE. _D!3713
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 appbtation. q
Dated this �_ day of _ !11J�120'-J�;—L
Subscribed and mom to before me the day and year first above writtan.
``'.1111111111/,I'
HgNS ''i
�•��pCV9y0
� Z. i
Q. F�OIAR), eo
;F
Pueo
cli
Pe
01f41l1S�1`
Notary ubbcol daho r�
R siding at:
My commission expires:
•....+num,:.f .n�1 .�nma' I:ntll l':iNl
R)holf
'49_XJ3 W a
8 odail( to
11•.-+•n 1 • N I
�
REXBURG
Affidavit of Legal Interest
State of Idaho
County of Madison I ,-
Name
-ke
Clicy�-
Being first duly sworn upon oath, depose and say.
(If Applicant is also Osmer of Record, skip to B)
Building Safety Department
City of Rexburg
35 North 1.1 East
Rcxbu% Idaho 83440
-
Addimn
SpA N n P�34�-ICS
state
A. That I am the record owner of the property described on the attached, and I grant my permission to:
MIADEWORNS 12443 W EXECUTIVE DR
WISE. _D!3713
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 appbtation. q
Dated this �_ day of _ !11J�120'-J�;—L
Subscribed and mom to before me the day and year first above writtan.
``'.1111111111/,I'
HgNS ''i
�•��pCV9y0
� Z. i
Q. F�OIAR), eo
;F
Pueo
cli
Pe
01f41l1S�1`
Notary ubbcol daho r�
R siding at:
My commission expires:
•....+num,:.f .n�1 .�nma' I:ntll l':iNl
R)holf
'49_XJ3 W a
8 odail( to
11•.-+•n 1 • N I