HomeMy WebLinkAboutHomeowners Affidavit AFFIDAVIT
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 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: /414 1e
(Property Owner, At r ey, or Power of Attorney)
C,
Printed Name: _..._.__..__' t` M G k J
STATE OF INDIANA
SS:
County of Q 11'O I --p n Before me the undersigned, a Notary Public
(County in which notarization takes place)
for PI r. I"1 CO C-IL_ County, State of Indiana, personally appeared
(Notary Public's county of residence)
WI ( f( C-m • 5p.e f Ob--i' and acknowledge the execution of the foregoing instrument
(Property Owner, Attorney, or Power of Attorney)
this ) 144-' — day of I— , 20 0N01
J)i`A,1ti,p, ANGELA G. HENRY Notary ublic--Signature
., S••'��j )tart' Public, State of Indiana
*j"" •*: 1 Hancock County
SEAL Commission N 8 Expire c G. ��
'a,��� o", ,`�; My Commission Expires
October 29, 2022
Not Public—Printed Name
My commission expires: OC4)12QT „,!?9,. oZ .
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