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<br />e <br /> <br />e <br /> <br />OWNERSHIP AFFIDAVIT <br />FOR INDIVIDUAL <br /> <br />STATE OF <br /> <br />Public Hearing No_ <br /> <br />COUNfYOF <br /> <br />Before me, the unde~igned authority, personally appeared <br />hereinafter the Affiant, who being duly Sworn by me, on oath, deposes and says: <br /> <br />1. Affiant is the fee owner of the property, which is the subject of the proposed hearing. <br /> <br />2. The subject propeny is legally described as: <br /> <br />J. Affi.-lIlt understands this affidavit is subject to the penalties of law for perjury and the possibility of voiding of <br />any zoning granted at public hearing. <br /> <br />Witnesses: <br /> <br />Signatw-e <br /> <br />Affiant's Signature <br /> <br />Print Name <br /> <br />Print Name <br /> <br />Signatw-e <br /> <br />Prim Nanle <br /> <br />Sworn to and subscribed before me on the <br /> <br />day of <br /> <br />,200 <br /> <br />Affiant is personally known (0 me or has produced <br /> <br />as identification. <br /> <br />Notary (Stamp/Seal) <br /> <br />G:>mmission Expires: <br /> <br />7 <br /> <br />PH2005 ed <br />