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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: ________________________________________
(Property Owner, Attorney, or Power of Attorney)
Printed Name: _______________________________________
STATE OF INDIANA
SS:
County of ________________________________________________ Before me the undersigned, a Notary Public
(County in which notarization takes place)
for __________________________________________ 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 ____________ day of ___________________________________, 20________
_________________________________________
Notary Public--Signature
(SEAL)
_________________________________________
Notary Public—Printed Name
My commission expires: _________________________________