City of Hickory – Variance Application
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6. OWNER’S AFFIDAVIT
We, the undersigned owner(s), hereby certify that the information contained herein and submitted in
support of this application is true and correct.
________________________________ ______________________________________
Printed Name of Owner Signature of Owner
(Please choose the appropriate notary block)
State of North Carolina – County of __________________
I, the undersigned Notary Public of the County and State aforesaid, certify that
_________________________________ personally appeared before me this day and acknowledged the
due execution of this foregoing instrument for the purposes expressed herein. Witness my hand and
Notarial stamp or seal, this _________ day of _____________, 20____.
My Commission Expires: ___________________ _____________________________
Notary Public
State of North Carolina – County of __________________
I, the undersigned Notary Public of the County and State aforesaid, certify that
__________________________________ personally came before me this day an acknowledged the he /
she is the ___________________________ of __________________________________ corporation /
limited liability corporation / general partnership / limited partnership (strike through the inapplicable),
and that by authority duly given and as the act of such entity he /she signed the foregoing instrument in
its mane on its behalf as its act and deed. Witness my hand and Notarial stamp or seal, this
____________ day of _________________, 20_____.
My Commission Expires: ___________________ _____________________________
Notary Public
This Application must be submitted to the Planning Department by 5:00 p.m. on the last regular working
day of the month preceding the meeting at which it is to be considered by the Planning Commission. Only
complete applications will be accepted.