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-H circ oaa9uxn County <br /> 46$3227 <br /> p_ 4 <br /> VW v' <br /> LOT LINE ADJUSTMENT <br /> 3 N JOA ulN <br /> zo-gyM D Y OPNt lYT DE'F MENr <br /> ALITHO ON S16N <br /> WN�R Op T E R N U O AGE=NT <br /> 1.the OwnerfAgent agree,to defend indemnifyg gains!the 4wnerfAgenPs project 'd held »i <br /> AppL! r <br /> procaedln a harless the County and its agents,officers and employees frim any claim,action or <br /> j <br /> t,fur-ther, Certify underpena/ty of perjury that i am(check one}; <br /> .K Lege!property owner(awner includes partner,to stcc,grantor,or corpolwre offrcer)or the property(s)Involved In <br /> this application,or <br /> Legal agent(attach proafof the owners consent to the application of the property,Involved in this application and <br /> have been authorized to file on their behalf.,end that the foregoing appiicatlan statements are true and correct_ <br /> Print Name: 'A P AI,E L M A M A I i A L <br /> Signature: <br /> Print Name: <br /> Signature: 7ato. <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date. <br /> Signature: 4 <br /> Prin t Name: Date: <br /> Signature: <br /> Date: <br /> e.psVHEw/x WAE/o Lw,AestlllLe�-PMEwCi�,P4ao1w 11Lv]/i/vs <br />