Affidavit of Legal Interest - signed V1(E IDI� I.�1\
APPROVED
DATE 07/28/22
RE NOR. -5
STATE OF IDAHO )
COUNTY OF ADA )
AFFIDAVIT OF LEGAL INTEREST
jp C�J ay
(name) (address)
pa(�Oka �JoMr',4 CA
(city) (state)
being first duly sworn upon, oath, depose and say:
That I am the record owner of the property described on the attached, and I grant my
permission to:
r H Qe.IH i.l C• , 5355 iNI CA 50c('er"6 91.3 g"Iac 1vQ
(name) (address) Sq„r 61eej pit CA q7,1 2 1
to submit the accompanying application(s) pertaining to that property.
2. i agree to indemnify, defend and hold the City of Meridian and its employees harmless
from any claim or liability resulting from any dispute as to the statements contained
herein or as to the ownership of the property which is the subject of the application.
I hereby grant permission to City of Meridian staff to enter the subject property for the
purpose of site inspections related to processing said application(s).
Dated this (o day of �A a4 20 Z Z
(Signatu15,
SUBSCRIBED AND SWORN to before me the day and year first above written.
otary Public for Idaho)
Residing at:
My Commission Expires:
i Aotall
cf-rt
(Rev 05/29/20)
C`(E IDI� I N
APPROVED
DATE 07/28/22
FaENUMBER: H-202-W5 NIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202
See Attached Document (Notary to cross out lines 1-6 below)
❑ See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary)
1
of Document Signer No. 9
Signature of Document Signer No. 2 (if any)
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document
to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
Countyof S Qn MoLi-t c)
,• SAMANTNA DIPPERT
Notary Public - California
i San Mateo County
Comrtrission 9 Z381945
_�My Comm. Expires Nov 6, 2025
Place Notary Seal and/or Stamp Above
Subscribed and sworn to (or affirmed) before me
on this day of a 20 9-91,
by Date Mo th Year
(1) M � Ch OL-2.1 M a-rRi'A
(and (2)
Name(s) of Signer(s)
proved to me on the basis of satisfactory evidence to
be the person(s) who appear More me.
Signature
Signature of Notary Public
OPTIONAL
Completing this information can deter alteration of the
fraudulent reattachment of this form to an unintenae(
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s1,Ottfer Than Named Above:
02017 National Notary Association
Number of Pages: