HomeMy WebLinkAboutAffidavit of Legal Interest Executed and NotarizedSubmit by E-mail
3S North 1 sr East
Rexburg, ID 83440
Affidavit of legal Interest
City of Rexburg
State of Idaho
County of Madison
I, M,k�lc s
Name
City
Phone: 208.359.3020
www.rexburg.org Fax:208.359.3022
Being first duly sworn upon oath, depose and say:
730 Al
Address
G A 8gns7
State
(If Applicant is also Owner of Record, sldp to B)
C IT Y OF
REXBURG
__ CW
Amairai Family Communfry
A. That I am the record owner of theproperty described on the attached, and I grant my
permission to: M I /, i T__4z 7.3o LV V 4e yU�=� 7
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 22 day of A- 1-
�0
Signature
Subscribed and sworn to before me the day and year first above written.
HELEN YOUNG
Notary Public - State of Utah
Comm. No. 725604
tis My Commission Expires on
• Jul 5, 2026
Residing at:
My commission expires: a'a Lo�