HomeMy WebLinkAboutAFFIDAVIT - 23-00147 - Kettle Embroidery - 61 E Main St - SignsSubmit by E-mail
35 North }s' East
Rexburg, ID 83440
State of Idaho
Affidavit of Legal Interest
County of Madison
Nance
City v
City of Rexburg
Phone: 208.359.3020
www.rexburg.org Fox: 208.359.3022
Being first duly sworn upon oath, depose and say:
Address
/11)
State
(If Applicant is also Owner of Record, skip to B)
(;T TY OF
REXBURG
Armrica,k hirnity (;)nunurrrty
A. That I am the reccard-.owner of the pro ert described on the attached, and I grant my '
permission to: ' f J -� •Y!/i fG 1"I ST4'�%�`
Name
Address
,1 --
B.
- �1c z
to submit the accompanying application f ertaining to that �roperty.
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
Signature
day of / �i- —,20 =.J
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
w
Q.w 2, V 0 ?
Residing at:
NUeti\o ;
Q
My commission expires; Q(� - Z'
o'�•%
`''1jT ,E�r,o��t�o