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Property OWNER'S AFFIDAVIT <br />1 hereby cartify that I am the legally authorized owner of all property involved In this <br />application or have been empowered to sign as the property owner on behalf of a <br />corporation, partnership, business, etc., as evidenced by separate instrument attached <br />herewith. I hereby grant to the applicant submitting this form full power to sign all <br />documents related to this application, including any conditions or litigation measures as <br />may be deemed necessary. <br />I declare under penalty of perjury that the foregoing is true and correct <br />Executed on (Date)az�� California <br />Property Owner's Signature/ „r{--'�a <br />Property Owner's Printed Name <br />2- <br />I hereby certify that the statements furnished above and in the attached exhibits <br />represent the data and information required for this initial evaluation and that the facts, <br />statements and information presented are true and correct to the best of my knowledge <br />and belief. Further, should the stated information be found false or insufficient, I agree <br />to the return of this form for appropriate revisions, understanding the City of Santa Are <br />cannot process this form until all applicable Information is corrected or provided by the <br />applicant. I hereby certify that I have been legally authorized by the property owner to <br />present this application and to sign on behalf of all documents related to this application, <br />including any conditions or litigation measures as may be deemed necessary. <br />Note; When the applicant is a corporation, partnership, business, etc., a separate <br />document verifying the authorization to sign for such applicant is required. <br />I declare under penalty of peLthatforegoing is true and correct <br />Executed on (Date) ? ✓ Vf jo -'t , California <br />Applicant's Signature <br />Applicant's Printed Name_ 6 1 vtJl I �Lr y t r <br />�i �eGt-o'�•�_�S <br />Pane 4 of 4 <br />5:PianningiGencal-CarAer r0(maW OQaprQCdIr00 <br />iH5 <br />32A-26 -- __ __ 5 1 ; l <br />