HomeMy WebLinkAboutauthorization of representationDEPARTMENT OF PLANNING AND DEVELOPMENT
723 West Markham Street
Little Rock, Arkansas 72201-1334
Phone: (501) 371-4790 Fax: (501) 399-3435
CERTIFICATE OF APPROPRIATENESS
AUTHORIZATION OF REPRESENTATION STATEMENT
do hereby authorize
(print)
2n to represent me and my interests in an
Agent/representative name and business (print)
Application for a Certificate of Appropriateness on the following property described below. I
have reviewed the proposed application and I have indicated so by initialing a copy of the
submittals that are attached.
Street Address:
t 3 t S Cu,rriberr10-4.d S Lt It e QaQ
f Bas -i D [ 6
Title Holder's Signature ate��l , ?Lq 0
Agent's Signature Date
Subscribed and sworn to me, a Notary Public on this /Z? 441 day of re_6 �.
t CARLA D. BRADLEY
Notary Public -State at Large VVVAl 1;�)
17NTUCKY - Notary ID # 503098
" anmission Expires January 22, 2018 Notary Public
My Commission Expires: ID —
Revised 8/2012