HomeMy WebLinkAboutAFFIDAVIT - 23-00118 - 208 Physical Therapy LLC - 1120 Stocks Ave - SignSubmit by E-mail
35 North I'1 East
Rexburg, U 83440
Affidavit of legal Interest
City of Rexburg
State of Idaho
County of Madison
I, Sterling Barnes
Name
Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3022
�o �aRerrR�
1120 Stocks Ave, Ste C
Address
CITY OF
REXBURG
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Rexburg ID
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 m`
permission to: Tyrel Nelson 1120 Stocks Ave, Ste C, Rexburg, ID
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 application.
Dated this / day of /iat✓Gh 207
Signature
Subscribed and sworn to bcf0,rc me the clay and Ycar Ilrst alx)\'r W61tren.
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Notary Public uf4didW1 alc-th
Victoria F Kreeb Residing at: �����9 ��zr-
Notary Public
Mecklenburg County, NC My commission expires: