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<br /> Owner/Agent
<br /> employees from any claim,action or proceeding against the Owner/Agenrs project.
<br /> 1,further, certify under penalty of pedury that I am(check one):
<br /> ■ Legal propertyIncludes ,
<br /> proofner,trustee,trustor,or corporate officer)of the
<br /> property(s)Involved In this application,or
<br /> Legal igent(attach
<br /> owner's
<br /> Involved . .
<br /> foregoing application statements are true and correct.,
<br /> Print Name:
<br /> .tSignat rf
<br /> • .r._. fi / Date:
<br /> Print Name: .
<br /> 31 nature,
<br /> Print Name:
<br /> Print Name: Signature:
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<br /> Print Name: Signature:
<br /> Date:
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