HomeMy WebLinkAboutOwner's AffidavitAFFIDAVIT
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: 1,
(Property Owner, Attorney, or Power of Attorney)
STATE OF INDIANA
SS:
Printed Name: W 1 \\ \ a,4r__� \VIJ t olyl�_
County of "-�XVN 1 �_:l C) �-\ Before me the undersigned, a Notary Public
(County in which notarization takes place)
for \A -�\- M t k —' , (0 )-� County, State of Indiana, personally appeared
(Notary Public's county of residence)
and acknowledge the execution of the foregoing instrument
(Property Owner, Attorney, or Power of Attorney)
this Q __� day of _\�sO'V �3 .1C� , 2t� U
(date) (month) (year)
�=� \ �A -
Notary Pub Ic--SI natur
(SEAL)
Notary Public --Please Print
GLENDA E. LANKOWSKi
�s�al Resident of Hamilton County, IN My commission expires: - 5 30 a
Commission Expires: Jan. 25, 2023
Page 3 of 12 Filename: Hearing Officer Development Standards Variance Application & Instructions 2020 Revised 1/2120