City
of Killeen ∙ Planning & Development Services Department ∙ (254) 501-7631
200 East Avenue D ∙ Killeen, Texas ∙ 76541
APPOINTMENT OF AGENT
As owner of the subject property, I hereby appoint the person designated below to act for me, as
my agent in this request.
Name of Agent:
Mailing Address:
City: State: Zip: -
Home Phone: (____) ______-__________ Business Phone: (____) _______ - ______________
I a
cknowledge and affirm that I will be legally bound by the words and acts of my agent, and by my signature
below, I fully authorize my agent to:
be the
point of contact between myself and the City: make legally binding representations of
fact and commitments of every kind on my behalf; grant legally binding waivers of rights
and releases of liabilities of every kind on my behalf; to consent to legally binding
modifications, conditions, and exceptions on my behalf; and, to execute documents on my
behalf which are legally binding on me. This authorization only applies to this specific
FLUM amendment request.
I understand that the City will deal only with a fully authorized agent. At any time it should appear that my
agent has less than full authority to act, then the application may be suspended and I will have to personally
participate in the disposition of the application. I understand that all communications related to this application are
part of an official proceeding of City government and, that the City will rely upon statements made by may agent.
Therefore, I agree to hold harmless and indemnify the City of Killeen, its officers, agents, employees, and third
parties who act in reliance upon my agent’s words and actions from all damages, attorney fees, interest and
costs arising from this matter. If my property is owned by a corporation, partnership, venture, or other legal
entity, then I certify that I have legal authority to make this binding appointment on behalf of the entity, and every
reference herein to ‘I’, ‘my’, or ‘me’ is a reference to the entity.
Signature of Agent: Title:
Printed/Typed Name of Agent: Date:
Signature of Property Owner: Title:
Printed/Typed Name of Property Owner: Date:
Signature of Property Owner: Title:
Printed/Typed Name of Property Owner: Date:
Signature of Property Owner: Title:
Printed/Typed Name of Property Owner: Date:
Signature of Property Owner: Title:
Printed/Typed Name of Property Owner: Date:
Signature of Property Owner: Title:
Printed/Typed Name of Property Owner: Date:
*Application must be signed by the individual applicant, by each partner of a partnership, or by an officer of a corporation or
association.
Application Revised: October 14,2020
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
