HomeMy WebLinkAboutProperty Owner AcknowledgementProperty Owner Acknowledgement
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V a ( (`i o it v t S (' 4u, the record owner for real property addressed
as -, t G• D�, S Y t �� t;�; 4 [ (� ,( $ am aware of, in agreement with, and give
my permission to . X -tv J T h �L-y- 1-{ urrF i3 pYeJ - to submit the
accompanying application(s) pertaining the that property.
1. i agree to indemnify, defend and hold the City of Caldwell and its employees harmless from any
claim or liability resulting from any dispute as to the statement(s) contained herein or as to the
ownership of the property which is the subject of the application.
2. 1 hereby grant permission to City of Caldwell staff to enter the subject property for the purpose of
site inspection(s) related to processing said application(s).
Dated this day of e� " 20 2,
(Signature)
CERTIFICATE OF VERIFICATION
STATE OF IDAHO
A-vt el ) ss.
County of -Cent' o )
a Notary Public, do hereby certify that on this day of
2022, personally appeared before me pct t 14-av- S , known or identified to me
to be the person whose name is subscribed to the foregoing instrument, who, being by me first duly
sworn, declared that she signed the foregoing document, and that the statements therein contained are
true.
NOTARY PUBLIC FOR IDAHO
Residing at
My Commission Expires 15f -
PAULA TERRY
COMMISSION NUMBER 37719
NOTARY PUBLIC
State of Idaho
My Commission Expires 05/01/2026