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35 North N East
Rexburg, ID 83440
Affidavit of Legal Interest
City of Rexburg
Phone: 208.359.3020
www,rexburg.org Fox: 208.359.3022
State of Idaho
County of Madison
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Name
Rexbu
City
138 W Main St.
Address
Idaho
State
C I T Y O r
REX-BU
--
'1171 .;Cae Ptuni!v C'�n�inumily.
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 my
permission to: Kenyon Crouch in behalf of Sign Pro 2274 W. Heritage Cir., Idaho Falls, ID 83402
Name address
to submit the accompanying application pertaining to that property. `5`q—"'—e_ .
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
rwhich is the subject of the application.
Dated this I day of0 Z
Signature
Subscribed and sworn to before me the day and year first above written.
S &ary Public of Idaho
om Residing at:
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PUBLIC o." � Z f
a
% . 3'h N o . 59•�,p �A My commission expires:
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