HomeMy WebLinkAboutRuss Squires Signe Affidavit 2023.06.27 (1)Submit by E-mait
35 North Is' Fast
Rexburg, ID 83440
State of Idaho
County of Madison
Name
t�( I�V�vtft
city) J
Affidavit of legal lnterzs�
City of Rexburg
Phone: 208.359.3020
www.rexburg.org Fax:208.359,3022
Address
State
C I T I o I'
EXB RG
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: t-yi Lc+H L- 1 0 Vnf ate_ j��
Name Address to Q>e v?,j
to submit the accompanying application pertaining to that property. J
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 off the application.
Dared this day of i )� p , 20
Signature
Subscribed and sworn to before me the day and year first above written.
OFFICIAL SEAL
' Q2a8 gr�r
o e Ashley Marie Bertram
NOTARY PUBLIC - ARIZONA
�a PINAL COUNTY
COMM # 594212
My Comm. Expires oecember6.2024
My commission expires: