HomeMy WebLinkAbout1450 N 2nd East - Affidavit of legal interest (signed)Affidavit of Legal Interest
Submit by E-mail City of Rexburg
35 North 1^East - Phone: 208.359.3020
Rexburg, ID 83440 www.,.xburg..,g Fax: 208.359.3022
State of Idaho
County of Madison
Name 1 Address
YY-A-1 �L 4VFLL< , to CL
City State
Being first duty sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
#_ CITY OF
REXBURG
Anrz" lnmily Cum ..
I o4= 57
A. That I am the record owner of the property described on the attached, and I grant my
permission to: Valerie barm 400 S Emporia St Wichita, KS 67202
Name Addtess
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 UFCCMSf2 day of /Y ,202i
Si azure
Subscribed and sworn to before me the day and year first above en.
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Notary Public of•"_'__ �(`rsc'xsaS
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