HomeMy WebLinkAboutHDC2016-002 Final Action 2DEPARTMENT 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
Property
3 es , L-1_L
(print)
name and business (print)
do hereby authorize
to represent me and my interests in an
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:
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Tit e Holder's Sign`iture k
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Agent's Signature
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Date
Subscribed and sworn to me, a Notary Public on this day of �atq 2a I
LY H. MADDEN
PULASKI COUNTY
FNTOTARY PUBLIC -- ARKANSAS
siori Expiw,Jiffy 31, 2022
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My Commission Expires: J L� L--( 3 i , 20 Z Z
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Notary Public
Revised 8/2012