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D SERVICES <br /> Service Facilities Needed City, Special District, etc . <br /> Water---- - ---- - -- �'�'� --- ---- <br /> Sewage � �— <br /> Drainage <br /> Electricity <br /> Gas <br /> Reason for the proposed Merger : <br /> _ w�.�- C�•� !� fes`r�c.�r''t- <br /> C1 SIGNATURE <br /> I certify under penalty of perjury that I am (check one ) : <br /> Legal Owner (s ) (All owners must sign as their names appear on the <br /> deed. ) , <br /> Corporate Officer (s ) empowered to sign for the corporation, <br /> LI Owner ' s legal agent (attach proof of the owner ' s consent to file <br /> the application ) , <br /> and that the foregoing is true and correct . <br /> n /ZZ5 <br /> (Signature ) (Date ) <br /> Merger of Parcels - 4 - ( 8/86 ) <br />