HomeMy WebLinkAboutCertificate Of Appropriateness Donna May 07-25-2013DEPARTMENT 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
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Pro eriy owner {print}
Agent/representative name and busines print
LC do hereby authorize
to represent me and my interests in an
Application for a Certificate of Appropriateness on the following property described below.
have reviewed the proposed application and I have indicated so by initialing a copy of the
submittals that are attached.
Street Address:
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Title Holder's _Sign ture / ate
i Agent's Signature Date
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Subscribed and sworn to me, a Notary Public on this 1 day of �>� f i i 3
JASON STONE
: COMMISSION # 12361266°r
EXPIRES: July 11, 2017
k' PulaskiCoun Notary Public
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My Commission Expires:
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Revised 8/2012