HomeMy WebLinkAboutHDC2016-019 certificate Of Appropriateness Authorization Of Representation Statement 07/007/20116DEPARTMENT 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
L6._ t 1 S+� G �J c, e_ do hereby authorize
Property owner (print) `
1�2AN 11 (f%, 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:
a
Title Holder's Signature Date
Agent's Signature
Date
Subscribed and sworn to me, a Notary Public on this day of 20 \yo
DANIELLE DAVENPORT
Notary Public -Arkansas
Saline County
My Commission Expires 02-23.2026
Commission 8 12696785
My Commission Expires: �-- 2 � -
1 1C�Yl�I }.}�G. • S ]C���`
Notary Public
Revised 8/2012