HomeMy WebLinkAboutAffidavit - Walter LoyaSubmit by E-mail
35 North W East
Rexburg, ID 83440
Affidavit of Legal Interest
City of Rexburg
Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3022
State of Idaho
County of Madison
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Name
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City
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CITY OF
REXBURG
Ameriws Family Community
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Address
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State
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: aadh Fork 1)esigh 1Z E rnain,5Ills 'Relcbang ID 934q5
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 (U()VC V r r-- day of FOV r , 20 2
Signature
Subscribed and sworn to before me the day and year first above written.
LIP—
MELINA DOUGLAS Notary Public of Idaho
COMMISSION # 200
32002
NOTARY PUBLIC Residing at: , S lb VW6-
STATE OFIDAHO
MY COMMISSION EXPIRES 05 0Y4M
My commission expires: