HomeMy WebLinkAboutHomeowner's AffidavitAFFIDAVIT
I hereby swear that I am the owner/contract purchaser of property involved in this application and that the foregoing
signatures, statements, and answers herein contained and the information herewi .h submitted are in all respects true and
correct to the best of my knowledge and belief. I, the undersigned, authorize the pplicant to act on my be�ialf with regard
to this application and subsequent hearings and testimony. Ae /f I
STATE OF INDIANA
SS:
Signed Name:
(Pro rty Owner, Attorney,; Po er of Attorney)
ey)
Printed Name: Vil f +f h Lam►% Itj_L j ItdV r]-
County ofBefore me the undersigned, a Notary Public
(County in which notarization takes place)
for MCA4County, State of Indiana, personally appeared
(Notary ublic's c unty of residence)
(4-�Ia—t-�qS` aya and acknowledge the execution of the foregoing instrument
(Property Owner, Attorney, or Pow of Attorney)
this day of A& 20. Qa
Not ry Public --Signature
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�mQ ° otary Public —Printed Name
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�: Mortgurriery Cuii^ty /
�Expires 04 0? �7�'' My commission expires: 04-01• 0�1
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Page 11 of 12 Filename: Hearing Officer Development Standards Variance FILLED IN Revised 12/29/2021