HomeMy WebLinkAboutAffidavit - Gierke (Lot 17)Affidavit of legal Interest
City of Rexburg
35 North P' East Phone: 208.359.3020
Rexburg, ID 83440 www.rexburg.org Fax 208.359.3022
State of Idaho
County of Madison
I, William Donald Gierke or Devyn Cote Gierke ,
Name
Rexburg
City
Being first duly sworn upon oath, depose and say:
1258 Stone Drive
Address
Idaho
State
C I T Y O F
R MURG
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(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: Mitchell Smedley 5624 Sorrel Dr, Pocatello, ID 83202
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 pffroperty which is the subject of the application.
Dated this � I st day of "! /`C , 20
Signature
Subscribed and sworn to before me the day and year first above written.
NIIIII/INM
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