HomeMy WebLinkAboutAgent of Record DesignationAGENT OF RECORD. DESIGNATION
Signatures- must be notarized.
I (We
C)Zndc.. 3M,_Cbr._,, hereby designate and -appoint
as. iny (bur) Agefit ,of Record for the purpose
of representingy change of use process. My (Our) Agent of Record is
M (our) the c
hqr6,by vpste
4 with the authority Wmake <any representations; agreements,. or promises as well as
:r , eje, or k0pt-A#yCondftlon§ imposed in conjunction with this matter.
Dated thi's day of 20 It
ApplicanilOWner's'Signature
Print Name
Agent's Signature.
Print,Name
STATE OF
COUNTY OFF . UgLe
The fagoing ,:irl§trUffient, was acknowledged
hefoid:ffidthis 1011m day ofov200.
By_&&t4u-, Cy F2,XJ
Who 'is rsonally -know 'to me or who as,
produced
as identification.
Signature of Notary
Commission Number (sdaal)
Expires- 011-31 201-'
S-Mo ove -
.Applicant/ Owner's Address
Phone:
Agent's Address
Phone.
AU]GH,
ERIOA.THOMPSON MUIRD
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