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LL : .,SINE ADJUSTMENT <br /> yy SAN JOAQUIN COUNTY CODUUNRY DEMOOWENT DEPARTMENT.. - <br /> t <br /> Mfir;F" .�' ,=RR •tT IY� 7R <br /> MAYA <br /> UM <br /> I,the Owner/Agent agree,to deflend,kxkwu ft,and hoed harmless the County and Its agents,often;and employees ftm any Naim,meow or <br /> proceeding against the Owow#Agmft prnjaet <br /> i,ftwd er, ow"undar penalty of p""that i am(check one): <br /> O Legal P+nPertlY o'er(Owrw brchndes pe'triv,trustee,,&ustor,or corporate officer)of the property(&)involved In No <br /> appocadom or <br /> O Legal agent(attach proof of the owners consent to the application of the property's devolved In this appilcatlon and have <br /> been aut0wked to file on gnelr behalf.,and that the fbrogoing application statemeris aro&us and correct <br /> Print Name: WILLARD C. COLLINS Signature: GZ/L �. j <br /> Print Name: LAVERNE M. COLLINS <br /> Signature: pato: _� "n <br /> Print Name: Signature: Date; <br /> Print Name: Signature: Date; <br /> Print Name: Signature: pate; <br /> i <br /> i <br /> i <br /> i <br /> i <br /> i <br /> i <br /> i <br /> i <br /> ' I <br /> i <br /> I <br /> .. i <br /> i <br /> i <br /> 1 <br /> I <br /> SRW AIIMY�NIY lWnnry tA>li� <br /> 4 i <br /> • I <br />