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35 North Ist East
Rexburg, ID 83440
Affidavit of legal Interest
City of Rexburg
State of Idaho
County of Madison
I� Brenda Fujimoto
Name
Rexburg
City
Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3022
Being first duly sworn upon oath, depose and say:
A.
1162 S 5th West
Address
Idaho
State
(If Applicant is also Owner of Record, skip to B)
CITY OF
ROE BUR
"W
niericai .Family t=.omfnunily
That I am the record owner of the property described on the attached, and I grant my
permission to: Sunrise Engineering 600 E Oak St. Pocatello, Idaho 83201
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 CG' day of '"� , 24
Signature
Subscribed and sworn to before me the day and year first above written.
1SAAC PARKER
NOTARY fte m • STATE Q F &W
COMMISSION NO.20244291
COMM. EXP.11/2512030
Notary Public of Idaho
Residing at:
-o—
My commission expires: IIZA4020