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I hereby swear that I am the owner/contract purchaser of propertypmperty 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
rr r,t to 'the, best of my knowledge and belief. r, the undersigned, authorize the applicant to act on my behalf with regard
to this application and subsequent hearings and testimony.
STATE of INDIA A
ount of
Signed tarn:
Property Owner, Attorney, or Power of tto)
Printed Name: iG wz �--.-
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(County in which notarization takes place)
Before me the undersigned, a Notary Public
y
fog "' County, State of Indiana, personally appeared
(Notary Public's county of residence)
�i f [,� G��� 17'C'•C:.1� and acknowledge the execution of the foregoing instnumertt
(Property Owner, Attorney, or Power of Attorney)
#his.._. j I day of
CAROL A DIXON
F_L Notary Public - Seal
Hamilton Count - State of Indiana
Commission Numt>er NP0733529
y Commission Expires May 6, 2029
Page 12 of 1
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