HomeMy WebLinkAbout07050083 Contractor AffidavitAUG-15-2007 WED 12:15 Ph CITY OF CARREL BC5 FAX NO. 3175712499 P. 03
x 1 AFFIDAVIT
J
-INDIAtt
DATE: Y- :AY- x m o 7
Building Permit f+ 0 rl bSQO 83 Issued: 051191-20 T be ?ed by Conbactnr
Notice is hereby given that. is no longer the
(Contractor's Name)
responsible party for die dove r?eferc p ject in whose name building permit # vL was
142- &O be built u ?R-
issued forme `'
(I of Construcuon) (Address)
As of ` /'v'- d 7 , responsibility for the completion of dtis project is being assumed by
(Date)
others.
..u.a..•s...... r. ... e..........• see......... a+./.?.
.. Contractor's Name (Doing Business As)
(Pri;hq (Date) n
Gonuactni s Address and Telephone Number: l f ,r?
STATE OF INDIANA )
SS
County of am- Ica)
Before mc, the undersignn/ee'd, a Notary Public for cz'? h County, State of Indiana,
personally appeared ,Ca I en h 1?5r and acknowledged
the execution of the for.;going instrument this +day of Amps , 20 •
No0ry PuEMy CanVnissiou Expires
Amt
STgT,ntR1AMd3v1btetdr6a t