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AFFIDAVIT
11 hereby swear that J am the owner/contract purchaser of property involved in this application and that the foregoing
signaturest statements and answers herein contained and the informahon herewith submitted are in all respects true and
correct to the best of my knowledge and behef. f I the undersjgned j authorize the appfica nt to act on my behalf with regard
to th is a p pI i cat i on and su bseq u ent h ea ri ngs and testi m 0 ny.
Signed: Ji.a i Y't) ~'{ ~1' jL & I2qb5
(pr perty Owner! Attbrney. or Power of Attorney) I Date
b,rYw rv1 tsuehnec
(PJease Print)
STATE OF rNDIANA
58:
County of
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Before me the undersigned, a Notary Public
(County in which notarization takes place)
for
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(Notary Pubtfc's county of residence)
County, State of Ind'ana. personally appeared
: . _. /i;,. .1. .J _. ~\ ' . ,
j,. . . .... .'.;' to;.... I "
(Property Ownerr Attorney, or Power of Attorney)
and acknowledge the execution of the foregoing instrument this
./
day of
I
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,
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(SEAL)
Notary Public-Signature
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Notary P ub1 ic--Ptease Prin~
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My commjssion expires:
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Pag e 4 of 8 - Z:\Sha red\forms\BZA a pp!ications\ Devejopment sta ndardS Variance AppJicatJon rev 03/01/05