HomeMy WebLinkAboutIdaho AffidavitAffidovit of Legol lnleresl
City of Rexburg
Phone: 208.359.3020
Fox: 208.359.i022
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Name fr'3e N ?ru w 5*e ll)
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City
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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 artached, and I grant my
oermission to:f
Name Address
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 staremenrs contained herein or as to the
ownership of the properfy which is the subject of the application.
Dated this A)n)ary or quqrY ,20 )4
Signature
Subscribed and swom to before me the day and year first above writren.
Notary Public of{deffi VTAY)
Residing ,t, AlvA\ C00At9, UhCl h
35 North lst Eost
Rexburg, lD 83440
State of Idaho
County of Madison
www.rexburg.org
Address
CHARLA K TAPMTOUTAI
Notary Public, State of Utah
Commission #7912?4
My Commission Expires
May 18,2027
My commission expires:
Connect Engineering 2295 N Yellowstone Hwy Unit 6