Created: 02-
22-2017, Updated 06-15-2017, Updated 09-09-2019
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ATTESTS AND SIGNATURES
State of Indiana )
) SS:
County of Hamilton )
I attes
t that all of the above information is true and correct to the best of my knowledge and belief. I understand that
any materially false, misleading, or incomplete statements on this application shall constitute grounds for denial of this
application and/or revocation of my request.
Owner’s P
rint Name
Owner’s Sig
nature (Required)
Subscribed and Sworn to before me this day of 20
Notary S
ignature
(Print
ed Name, Commission Expires, Resident of What County or STAMP)
Appli
cant or Developer’s Printed Name
Applicant or Developer’s Signature
Subscri
bed and Sworn to before me this day of 20
Notary S
ignature
(Print
ed Name, Commission Expires, Resident of What County or STAMP)
PRIOR TO ANY SUBMITTALS FOR THE NOTED APPLICATIONS, A PRE-FILING MEETING IS REQUIRED WITH
PLANNING DEPARTMENT REPRESENTATIVES.
Pre-Filing Meeting Date
Planning Representative(s)
__________________________________________________________________________________
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___________
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