HomeMy WebLinkAboutShadow Glen 3_OwnerAckJim Sansburn, CFO, Hayden Homes ldaho LLC , the record owner for real property addressed
as Shadow Glen Subdivision No 3 am aware of, in agreement with, and give
my permissiep 16 Ardurra , 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. I 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).
Property Owner Acknowledgement
31"day of Mook 202\
(Signature)
Dated this
CERTI FICATE OF VERI FICATION
STATE OF OREGON )
County of Deschutes )
) ss.
l, 6imYrr.\{ e\riloe,B a Notary Public, do hereby certify that on this 9\- day of
n/laa,c-h 2029, personally appeared before me SimScrsrorcrl 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 iDIrFtO &,@q
Residing at Oegd.roasS
@
OFFICIALSTAMP
KIMBERLY DIANE GUTTIRI€
NOTARY PUBLIC.OREGON
coMMtssroN No.987928
MY COMMISSION EXPIRES MAY 20, 2023
My Commission Expires tr)aq 40.