HomeMy WebLinkAboutAFFIDAVIT - Parkgreen (1)Submit by E-mail
35 Norih I" East
Rexburg. ID 83440
Affidavit of legal Interest
City of Rexburg
Phone: 208.359,3020
www.rexburq.org Fax:208.359.3022
01
State of Idaho I -- -----
County of Madison, f�c� en ^L _C
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Name Address
�P__e.Y rg
City
Being first duty sworn upon oath, depose and say:
State
T do\�\o
(If Applicant is also Owner of Record, skip to B)
r. I I Y U f
REXBURG
CW
Ame,ird, family Cn.n nn�n ny
That I am the record owner of the property described on the attached, and I grant my
permissionto: Elevated Land Surveying 3534 Apolena Avenue, Idaho Falls, Idaho
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 �_Q� day of (5 C A 0�2-4- , 20
Signature
Subscribed and sworn to be me the day and r first above itten.
A t iam pvbk a ether eMar pet�N11K tM/ aatflkete ot+* skiNotary Public of Idaho
Want" of the 6e/fYWOM wow or" 1W dwmw to W" Im moat@
is attedaA ew ad the vilil"At"M swam ert aft rf tAM fM .. III- Residing at:
state of G1Ma
County Of no My commission expires:
o -enr wrem M I�a� ! me an � a� � �
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proved to nN On the
�t�.:°,. ` APRIL M. JOHNSON
Will; \; Votary Public - California
of satisfactory evidence to a the persoM who appeared before me. San Francisco County
Signature (Seal) Commission ; 2380962
«�''• My Comm. Expires Nov 13. 2025