HomeMy WebLinkAboutOwners 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:
(P operty Ow r, Attorney, or Power
of Attorney)
Printed Name: Q NC.0 �(1 40 O` � �J1/4/
STATE OF INDIANA
SS:
County ofA 0.--1 Before me the undersigned, a Notary Public
(County in which notarization takes place)
for “1N11 County, State of Indiana, personally appeared
(Notary Public's county of residence)
Vtpt-(2 j N3 rA 12-D * and acknowledge the execution of the foregoing instrument
(Property Owner, Attorney, or Power of Attorney)
this l day of 2G j-1 , 20 D3
p,K SIMq
OP' SEAL NS'1j
NOTARY PUBLIC '; Notary Public--Signature
(SEAL) =
Commission =
Number
NP0745831
My CEommission (U(A
J` SKAP,N)a
y Jan 3, es xp�r2031 - Notary Public—Printed Name
dX 414 7onicoy t.
OF INO
My commission expires:
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