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UPISVIP <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OP TME PROPERTYORANAUTHORITED AGENT NAYRLEAN APPLICATION. <br /> 1,Ne OwnaNAgent agree,fo defend,IMemn/fy,and hold harmless Ne County antl ifs agents,omrers antl employees hom any <br /> Clalm,action orprocaeding against me OwnevAgenrs pmje <br /> I,fat er, certNy underpenalry ofpedj,Mtl am(check.n): <br /> Xgal property owner(ownerincludespadnen trustee,Nestor or corporate officer)of fhepropenfe) <br /> Involved in mis aMkadon,or <br /> ❑ Legal agent(affach pmofofine o~s consent to We application ofine property's involved in this <br /> application and have been authorized to file on mel,bahatil <br /> and mat me foregoing application statements ere due and conea <br /> Print Name: PETER M.BRIDGES Signature: Date: 5132017 <br /> Print Name: Signature: Date: <br /> Prim Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Mountain lio.&MNAppreatFon Fams4NH-UPSA�P humMASTERdoc <br /> A <br />