HomeMy WebLinkAboutHDC2012-006 Certificate Of Appropriateness Authorization Of Representation Statement 03/30/2012p� LITTLE ROCK
'oil] HISTORIC
i f DISTRICT
COMMISSION
DEPARTMENT 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
191�E 000
Property owner (print)
do hereby authorize
to represent me and my interests in an
Agendrepreseritative 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:
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Title Holder's Signature
Agent's Signature
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Date
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Subscribed and sworn to me, a Notary Public on this,_ day of , �.01142'.
My Commission Expires: �; o
Notary Public
MATTHEW 0 TOENNIES
NAANG 00UNiY, AFt mum
M. WW. Mf4L 15, 201S Revised 6/2011
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