HomeMy WebLinkAboutRuss Squires Signed & Notorized AffidavitSubmit by E-mail
35 North Izt East
Rexburg, ID 83440
Affidavit of legal lnteaTst
City of Rexburg
State of Idaho
County of Madison
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Phone: 208.359.3020
www,rexburg.org Fox: 203.359.3022
VD. --I l ,,
Address
State
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, ship to B)
A. That I am the record owner of the property described on the attached, and I grant my
permission to: Y -`e7 Ir, r t-1 �t Liam" l- ` 4-J L- # ii tn!_ l t[�•
Dame Address
to submit the accompanying application pertaining to that property, `3
B. i agree to indcrnnif ,, defend and hold Rexburg City and its employees harmless from any
claim or liability, resultino- 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 ofz 1 ?(} —
Signature
Subscribed and s-vvorn to before me the day and year first above written.
OFFICIAL SEAL
o e Ashley Marie Bertram
NOTARY PUBLIC . ARIZONA.
FINAL COUNTY
COMM # 594272
My Gomm. Expires p) c mber 6.2024
ZMy commission expires:_ Msk