HomeMy WebLinkAboutApplication UVAFFIDAVIT
I, hereby swear that 1 am the owner/contract purchaser of property involved in this application and that the foregoing
signatures, statements and answers herein contained and the information herewith submitted are in all respects true
and correct to the best of my knowledge and belief. I, the undersigned, authorize the applicant to act on my behalf
with regard to this application and subsequent hearings and testimony.
Signed Name:
(Property Owner, Attorney, or Power of Attomey)
STATE OF INDIANA
SSA
Printed Name: 0 C,_o
The undersigned, having been duly sworn upon oath says that the above information is true and correct and he is
informed and believes.
(Signature of Petitioner)
County of r.�W�-I���a� _ Before me the undersigned, a Notary Public
(County in which notarization takes place)
for 1�--s�•< o's County, State of Indiana, personally appeared
(Notary Public's county of residence)
—. ,po �\ Wo•��e�� and acknowledge the execution of the foregoing instrument
(Property Owner, Attorney. or Power of Attorney)
this _^ e day of O�,. 20 :�D
(day) (month) (year)
Notary Public —Si V
ature
Notary Public —Please Print
My commission expires:
(O'e'Oe
STEVIFN T ALLISONJR.
Resident or Hendr cks county
Comm ss on Exp res 5 27.202;
Page 3 of 12 Filename use variance application R instructions 2020 Rev 112/2020