HomeMy WebLinkAboutPacket 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:
/0/fr-3
(Property Owner, Property Owner's Attorney (Date)
or Property Owner's Po er of Attorney)
4#
(Please Print)
STATE OF INDIANA
SS:
County of Before me the undersigned, a Notary Public
(County in which notarization takes place)
for 4::T 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) -f, ,;c -7 G eicC J
this day of Oe-j-Y e;""" 2l)a 3
Pr/1/1/A--
Notary Pub Signature
(SEAL) ff (SEAL)
Notary Public Please Print 1
My commission expires: ,c
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