HomeMy WebLinkAboutGB070010_Agent Notarized LetterAgent Authorization and
Notarization Form
County of Orange
(1) PROPERTY OWNER OF RECORD (2)
(print or type and sign)
NAME 6k&V- I
COMPANY NAME TJL6ha1/ AfifA %//6J �I ITk+
MAILING CsdA� Ted" or
ADDRESS
CITY
STATE ZIP 4Z&, %
PHONE �glQ OLiM
FAX `Z `i 4 &I"D q ZI CO
AUTHORIZED AGENT
(print or type)
NAME Qav, ca Wa,,ra
COMPANY NAME fUaTtly 4.C"Jymo..T.ToC
MAILING jcD Alq l,k s 5,, 47 208
ADDRESS
CITY Srvt,c
STATE Coo- ZIP S6L(016
PHONE 9gi- i}15-091111
FAX 4M9- Oil -0'2'17
EMAIL claviZ e N.,.No 6rvr*wfr»7`
I am the current owner of record of the property which is subject of this application. I approve
the indicated authorized agent to submL�t� questel
PROPERTY OWNER SIGNATURE: IY)
t
State of California
County of A&
On
261
Date
Personally appeared
who proved to me on the basis of satisfactory evidence to be the person(s) whose names(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed the same his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the instrument.
RENEE L. MOLIOY I certify under PE LTY OR PERIU nder the laws of the State
Commission # 1768
LOY of California that a foregoing p graph is true and correct.
Notary Public - California I �
Orange County ��� //n/,
Place Notary Seal Above
PLANNING & DEVELOPMENT SERVICES 1300 N. Flower Street, Santa Ana, CA 92703 1 ATTACHMENT 21 PAGE 14