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HARDY & HARPER, INC.
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Last modified
11/14/2024 3:02:46 PM
Creation date
9/19/2012 1:33:42 PM
Metadata
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Template:
Contracts
Company Name
HARDY & HARPER, INC.
Contract #
13-6780
Agency
Public Works
Council Approval Date
9/17/2012
Destruction Year
2017
Notes
Project
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CALIFORNIA JURAT WITH AFFIANT STATEMENT <br />C�See Attached Document (Notary to cross out lines 1 -6 below) <br />O See Statement Below (Lines 1 -6 to be completed only by document signer(s], not Notary) <br />i <br />2 <br />4 <br />5 <br />Signature of Document Signer No. 1 <br />State of California <br />Orange <br />County of <br />Place No[ary Seal Above <br />Signature of Document Signer No. 2 (if any) <br />Subscribed and sworn to (or affirmed) before me <br />14 August 12 <br />on this day of 20 , <br />Data Mon[h Year <br />by <br />Steve Kirschner <br />(1) , <br />Name of Signer <br />proved to me on the basis of satisfactory evidence <br />to be the person who appeared before me (.) (,) <br />(and <br />None <br />Name of Signer <br />proved to me on the basis of satisfactory idence <br />to be th son w appeared f e me.) <br />Signature <br />r Signature of Notary Pu lic <br />OPT /ONAL <br />Though the information below is not required by /a w, it may prove valu- <br />able to persons relying on fhe document and could prevent fraudulent <br />removal and reattachment of this form to another document. <br />Further Description of Any Attached Document <br />Non - Collusion Affidavit <br />Title or Type of Document: <br />8/1 14/2012 <br />Document Date: Number of Pages: <br />None <br />Signers) Other Than Named Above: <br />1 <br />RIGHT THUMBPRINT RIGHT THUMBPRINT <br />OF SIGNER N1 OF SIGNER #2 <br />v zuve rvanona� rvorary nssodenon rvanonawo[ary.org l- BOO -US NOTARY (l- BOO -876 -6827) Item #5910 <br />- <br />JO -ANN LYONS <br />COM M. #1841329 <br />'` /_�:�.':_ _ <br />N <br />No[ary Pu blio�all}Ornla C <br />`�`!� My <br />ORANGE COUNTY c <br />Conun. Eapiras Apr. 17, 2013 <br />Place No[ary Seal Above <br />Signature of Document Signer No. 2 (if any) <br />Subscribed and sworn to (or affirmed) before me <br />14 August 12 <br />on this day of 20 , <br />Data Mon[h Year <br />by <br />Steve Kirschner <br />(1) , <br />Name of Signer <br />proved to me on the basis of satisfactory evidence <br />to be the person who appeared before me (.) (,) <br />(and <br />None <br />Name of Signer <br />proved to me on the basis of satisfactory idence <br />to be th son w appeared f e me.) <br />Signature <br />r Signature of Notary Pu lic <br />OPT /ONAL <br />Though the information below is not required by /a w, it may prove valu- <br />able to persons relying on fhe document and could prevent fraudulent <br />removal and reattachment of this form to another document. <br />Further Description of Any Attached Document <br />Non - Collusion Affidavit <br />Title or Type of Document: <br />8/1 14/2012 <br />Document Date: Number of Pages: <br />None <br />Signers) Other Than Named Above: <br />1 <br />RIGHT THUMBPRINT RIGHT THUMBPRINT <br />OF SIGNER N1 OF SIGNER #2 <br />v zuve rvanona� rvorary nssodenon rvanonawo[ary.org l- BOO -US NOTARY (l- BOO -876 -6827) Item #5910 <br />
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