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23B - BRISTOL ST REHAB
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12/17/2019
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23B - BRISTOL ST REHAB
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Last modified
12/12/2019 5:43:58 PM
Creation date
12/12/2019 5:33:35 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23B
Date
12/17/2019
Destruction Year
2024
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CALIFORNIA JURAT GOV CODE § 8202 <br />A notary public or other officer completing this certificate verifies only the identity of the individual who signed the <br />document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. <br />State of California <br />County of Riverside <br />COURTNEY CHAPAB <br />Notary Public -California <br />Riverside County <br />d �vrrwv�'c' <br />Commission # 2172984 <br />tdy Comm. Expires Nov 20.2020 J <br />Subscribed and sworn to (or affirmed) before <br />me on this 16th day of October. 2019 <br />Date Month <br />By (1) Edward J. Carlson <br />Name of Signer <br />Proved to me on the basis of satisfactory evidence <br />be the person who appeared before me (.) (,) <br />(2) <br />(And <br />Name of Signer <br />Proved to me on the basis of satisfactory evidence <br />be the person who appeared before me.) <br />Signature <br />Place Notary Seal Above Signally <br />ignat of Nota U <br />Public <br />OPTIONAL <br />Though the information below is not required by law, it may prove <br />valuable to person relying on the document and could prevent <br />fraudulent removal and reattachment of this form to another document. <br />Further Description of Any Attached Document <br />Title or Type of Document: Ownership Affidavit <br />Document Date: 10-16-2019 Number of Pages: 1 <br />Signer(s) Other Than Named Above: <br />Top of thumb here <br />Top of thumb here <br />23B-15 <br />
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