HomeMy WebLinkAboutAuthorization of Representation AffidavitEkCHy of LMtle Rock `y o1_ U 190
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723 west 4larknam Street
Little ROrk. Ark n 72201.1334
Phone 1501) 3714790 90 FM 1501i 399-3435 PLANNING & DEVELOPMENT
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AUTHORIZATION OF REPRESENTATION AFFIDAVIT
I, 1drAtrG jl /e do hereby authorize
Property/owner (print)
represent me and my interests in an
(print A ent's name and busme ) /
Application for ��! lfa _ on the following property described below.
(type of application(s))
I have reviewed the proposed application and I have indicated so by initialing a copy of the submittals that are
attached.
Property described as.
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Street Address:
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R 13A, z/Ug 2Z
Title Holder' igna r Date
Agent's Signature Date
Subscribed and swom to me, a Notary Public on this day of
Notary Public
My Commission Expires:
LUPLM2020.a . Pace 3o13 revie 5/6/2020
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Property described as:
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" Signature 6fTitle Holder
AFFIDAVIT
ty by my signature below that I hereby
act as my agent regarding the
of the below described property .
z1j9) zy
Date
Subscribed and sworn to me a Notary Public on this day of
Notary Public
My Commission Expires:
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DIFLONCINC TO
1ANCY BROWN
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