AffidavitAFFIDAVIT OF LEGAL INTEREST
STATE OF iDAHO
COUNTY OF ADA
/ f� /�j�/_ (address)
(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:
(name) (address)
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.
3. I hereby grant permission to City of Meridian staff to enter the subject property for the
purpose of site inspections related to processing said apptication(s). I
Dated this day of ��l(� �i✓YI� 20 oC `
t
SUBSCRIBED AND SWORN to before me the day and year first above written.
See the Attached CAA
❑Acknowledgment or
Murat Form
J.B. Sw III, Notary,'Pubk
00312102r
(Notary Public for Idaho)
Residing
My Commission Expires:
33 E. Broadway Avenue, Suite 102 • Meridian, Idaho 83642
Phone: (208) 887-2211 • Facsimile: (208) 887.1297 • Website: www.meridiancity.org
CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202
- - -A
Of 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)
Signature of Document Signer No. I
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
County of C r V G/c-
*My
J. S. SWAN III
Notary Public • California
Orange County
commissionN ZZ5031Z
Comm. FapiresAut 15. 2022
Seal
Place Notary Seal Above
Subscribed and sworn to (or affirmed) before me
on this � day of P 1 20L
by Date / Month Year
n)��reQ VAl_ ICA C
(and (2)
NameX of Signe pw
proved to me on the basis of satisfactory evidence
to be the person who appeared before me.
Signature
'`3i otary Public
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Do ument I Aff tiK j
Title or Type of Document: 1061 / Document Date: D Z I zo 2- N
Number of Pages: ( Signer(s) Other Than Named Above:
02014 National Notary Association • www.Nationa]Notary.org • 1-800-US NOTARY (1-800-876-6827) Item #5910