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35 North 1st East
Rexburg, ID 83440
Affidavit of Legal Interest
State of Idaho
County of Madison
MIR
Rexburg
City
City of Rexburg
Phone: 208.359.3020
www.rexburg.org Fox:208.359.3022
pI!\ B
1174 N. Yellowstone Hwy
Address
ID
State
C I'rY O F
REXBURG
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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 attached, and I grant my
permission to: Raymon McDougal 427 Stegelmeier Ln., Rexburg ID
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 statements contained herein or as to the
ownership of the property which is the subject of the application.
Dated this X44 , 2 day of . J , 20V_
Signature
Subscribed and sworn to before me the day and year first above written.
DANNA WEEKES Notary Public of Idaho
Notary Public
State of Idaho Residing in Rexburg, ID
Commission No. 18412 Residing at: xPires 028
My commission expires: