HomeMy WebLinkAboutOwners AffidavitAFFIDAVIT
(I/We), being duly sworn, depose and say that (I/We) (am/are) the (owner(s)) of Fifty Percent (50%) or more of the
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 or our) knowledge and
belief.
Signature (typed or printed)
/6q0_2
Address
City, State, ZIP
The applicant, correspondent, or agent (if different from owner or owners)
Name
Telephone/Email
Date
STATE OF INDIANA
SS:
Name
Telephone/Email
Date
The unde d,.having been duly sworn upon oath says that the a i o ation is true and correct and he is
informed nd be 4vi
(Signature of Petitioner)
County ofd �9q Before me the undersigned, a Notary Public
/,
(County in which notarization takes place)
for /4 W i / �y 0 County, State of Indiana, personally appeared
9 (Notary Public's county of residence)
l
§UI v"_ 5 and acknowledge the execution of the foregoing instrument
(Property Owner, Attorney, or Power of Attorney)
this TGl day of_�� �i�liL! 20
(day) (month) (year)
CHARLES J CARL SON Notary P lic--Signature
NOTARY PUBLIC C11-tY c 5 ./ C"111114
SEAL Notary Public --Please Print
STATE OF INDIANA
Commission Number NP0738094 My commission expires:
My Commission Expires 12/26/2029
(date)
Revised: 5/12/2022 Filename: Rezone or PUD Application 2022 Page 2 of 7