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BROEKHUIZEN, JACO & AMANDA-2015
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BROEKHUIZEN, JACO & AMANDA-2015
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Last modified
1/22/2016 4:16:03 PM
Creation date
1/22/2016 3:24:12 PM
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Contracts
Company Name
BROEKHUIZEN, JACO & AMANDA
Contract #
A-2015-269
Agency
PLANNING & BUILDING
Council Approval Date
12/1/2015
Destruction Year
2030
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or <br />State of California <br />County of Orange <br />}SS. <br />CIVIC CODE § 1189 <br />On December 21, 2015 before me, Karen C. Gerardo, Notary Public <br />Date Name and Title of Officer (e.g„ "Jane Doe, Notary <br />Public ") <br />personally appeared Jaco and Amanda Van Broekhuizen <br />Na.(s)ofSignersj <br />�who proved to me on the basis of satisfactory evidence to be the person(s) whose names,) <br />'q. J" subscribed to the within instrument and acknowledged to me that Wek the <br />executed the same in hwh their authorized capacity(ies), and that by <br />hffe hei signature(s) on the instrument the person(s), or the entity upon behalf of which <br />the person(s) acted, executed the instrument. <br />I certify under PENALTY OF PERJURY under <br />the laws of the State of California that the <br />`�` KARM C `af l C foregoing paragraph is true and correct. <br />Commission 0 211 tgit9 <br />ftwy ftm- won. WITNESS my hand and official seal. <br />Crsnys Cou" <br />t t <br />Signature of Notary Public <br />Place Notary Seal Above <br />OPTIONAL <br />Though this section is optional, completing this information can deter alternation of the document or fraudulent <br />reattachment of this form to an unintended document <br />Description of Attached Document <br />Title or Type of Document: <br />Document Date: Number of Pages: <br />Signer(s) Other Than Named Above: <br />Signer's Name: <br />Capacity(ies) Claimed by Signer(s) <br />❑ Individual <br />❑ Corporate Officer - Title(s):_ <br />❑ Partner -- ❑ Limited ❑ General <br />❑ Attorney in Fact <br />❑ Trustee <br />❑ Guardian or Conservator <br />❑ Other: <br />Representing: <br />❑ Individual <br />❑ Corporate Officer — Title(s): <br />❑ Partner -- ❑ Limited ❑ General <br />❑ Attorney in Fact <br />❑ Trustee <br />❑ Guardian or Conservator <br />❑ Other: <br />Signer is Representing: <br />
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