HomeMy WebLinkAboutAFFIDAVIT - 22-00655 - Madison Memorial Hospital - Storage ExpansionAffidavit of Legal Interest
Submit bCity of Rexburg
35 North Int East Phone: 208.359.3020
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3022
State of Idaho
County of Madison
IMadison Memorial (Amos Kington
Name
450 E. Main St
Address
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C I TY OF
REXBURG
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Atneiic; 1"arnily Community
Rexburg Idaho
City State
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: Nicholas Segard 925 S. Utah Avenue, Idaho Falls, 83402
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
claitn 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 31 day of August 2022
Signature
Subscribed and sworn to before me the day and year first above written.
••'�°+''•�'� Notary Public of Idaho
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