HomeMy WebLinkAboutAFFIDAVIT - 23-00222 - 125 Valley River Dr - Goodwill - Suite 201I Submit by E-mail
,35 Narih 1 �J E00
Rexburg, fb 83440
State of Idaho
ffidavit of Legal Interest
City of Rexburg
Prone, 208.359.3020
www..rc,xbur-g-&-g fox: 208,359.3022
County of Madison
C 14 L2 A r- K A ry q PIN a e, L- K -
Name Addrvsti
C IT Y OF
REXBURG
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Afflvm4 himdY ubmilurijuy
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City State
Being first duly �vvorn upon oath, depase and say -
(If Applicant is also Chvnev of Reca4 sidp to Ift)
A- Viat I am the rer-ord n%-ner of the property dc&cribed on the atmchvd. and I g -rant my
permig-,1011to: JAR -6f 04OULT"Y Id Chu, t Fa I I -.-
Name Address
to submit the accompanying applicatIon pertxinirtg to chat property.
I agree to indemnify,, de&nd and hold Rexburg City and ]tSCMPj0YCCN hattTl[Oss from any
claim or liability resulting ftorn any dispute as to the statements con aired heirulrL or as U.) the
uwnersiLip of the propctty which is the subject of the applicafion-
Daied Ibis day of
ZC-
Subscribed and swam to befotc me the day and year 5 above written.
Notmq Public of Idaho
Residing at;
My conimission expires:
sem iitt �l,e�C
CALIFORNIA ACICNOWLEDC;MENT
CIVIL CODE § 1189
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A rota ry pu biic of other officer completing this certificate verifies only this identity of the individuai who sig ried the document
to which this certificate is attached, i rnd riot the truthfu I riess, accuracy, or validity of that document.
State of California
County of 5dK1 n tr_SLI re
[ F �'+
On , ! _(1 C before me, _ I A IG ?t 'I � � I C at� Yr J
Date Here Insert Name and Ttle of the Officer
personally appeared
l+lorrre(s) of Srgr�er[s�+
who proved to me nn the basis of satisfactory evidence to be the persop("hose riarnea 5 I re subscribed
to the within instrument and acxnowledged to me tha he helthey executed the same <2erltheir
authorized rapacity(jand that b hi)heiltheir signature(s) on the instrument the persorq(rxj; or the entity
upon behalf of which the persons) acted, executed the instrument,
� � f4�T f�IM GHhaR►,P+
1 avatar± Pubsit- California
5ania Clara Cod"
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Camrmi55lon d 236703
�y Con m. Exp reE Jul 11. 2025
Place Notary Seal andlor Stamp Above
certify under PENALTY OF PERJURY under the
laws of thy: State of CaI!to rnia that the foregoing
paragraph is true and c+arreCt,
WITNESS my hand and official seal,
AT-6� Z�L
Signature_
Signatui%- of Notary Public
OPTIONAL
Compietitrg this rr ormotion can deter alteration of thea doca Trent or
fraudrrient re ttochment of this farm to cin unintended docurr cot
Desc6ptian of Attached Document
Title or Type of Document:
Document Date: Nurnber of Pages4
Signer(s) Other Than Niarned Above:
Capacity(ies) Claimed by Signer(s)
Signer's blame:
m Corporate Officer — Title(s)'
❑ Partner — C3 Limited Q Certeral
❑ Individual ❑ Attorney in Fact
❑ Trustee D Guardian of Conservator
El Other,
Signer is Reprosenting:
Signer's Mame.
❑ Corporate Officer — T-dile{s}:
❑ Gartner — ® Limited D General
❑ Inidividual ❑ Attorney in Fact
® Tnistee ❑ Guardian or Conservati�r
0 Other,
Signer is Representing=
._wot"MMMEK s APJ
2019 Nationr it Notary Association