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23A - PROJ - PED IMPROVEMENTS SA BLVD
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12/20/2016
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23A - PROJ - PED IMPROVEMENTS SA BLVD
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Last modified
12/19/2016 10:33:08 AM
Creation date
12/15/2016 4:14:27 PM
Metadata
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23A
Date
12/20/2016
Destruction Year
2021
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CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 <br />lY"4'L"- `fi�4c£e�-f..c-„'cs�dS' 2lY',t^,S3��Y'.c^CaY;�izrm,:rsf!:s;rCcY;xn:.;ss°`..C�.�E'C.s`,C;fruz..rs>as`ficcy`d.`Cds`bY`s,4'cSaGY}L^a.^"YAG ;C,i`E;fe'�"..rz-t�rt <br />CI See Attached Document (Notary to cross out lines 1-6 below) <br />Ct See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) <br />Signature of Document Signer No. i Signature of Document Signer No. 2 (if any) <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 Orange <br />TINA PNAM <br />COMM.#214@384 <br />Asa' <br />Notrary PubIIC.CaI'r.mla a <br />P"� <br />ORANOE COUNTY <br />�: <br />My C4f0M F.xi Apr 17, 2020 <br />Seal <br />Place Notary Seal Above <br />Subscribed and sworn to (or affirmed) before me <br />on this —14-- day of November 2016, <br />, <br />by DateMonthYear <br />(and (2)- _ ), <br />NameO of Signer( <br />proved to me on the basis of satisfactory evidence <br />to be the person( who appeared before me. <br />Signature 9""' -- <br />Signature of Notary Public <br />OPTIONAL <br />Though this section is optional, completing this information can deter alteration of the document or <br />fraudulent reattachment of this form to an unintended document. <br />Description of Attached Document <br />Title or Type of Document: Non -Collusion Affidavit _Document Date: November 14, 22 <br />Number of Pages: �Signer(s) Other Than Named Above: None <br />02014 National Notary Association • www.Nationa[Notary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5910 <br />23A-28 <br />
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