HomeMy WebLinkAboutsigned affidavit or legal interest Rexburg SignedSubmit by E-mail
35 North In East
Rexburg, ID 83440
Affidavit of Legal Interest
State of Idaho
County of Madison
r
City
City of Rexburg
Phone: 208.359.3020
w w.rexburg.org Fax: 208.359.3022
Being first duly sworn upon oath, depose and say:
A.
of pexougc
CITY OF
REXBURG
America's Family Community
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Address Q
State
(If Applicant is also Owner of Record, skip to B)
That I am the record owner of the property described on the attached, and I grant my
permission to: 13oumaUSA 3MWM vim Dr. S M,Gum l Ws. M1QW
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 c� JL— day of C . AA,-t,6 20 2 S
0- f /
Signature
Subscribed and sworn to before me the day and year first above written.
`'VO� "S'' ( WREN ""'//,
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Notary Public of Idaho
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o,R?tSSIONN� My commission expires: