If an agent is authorized by the property owner to file and execute the application on behalf of the property
owner, the agent must complete the affidavit below.
STATE OF TEXAS
COUNTY OF MIDLAND
Before me, the undersigned authority, on this day personally appeared ___________________________ who, being by
me duly sworn, upon oath says: That (s)he is authorized by __________________________, the owner of the above
described property, to fully represent him/her in this application and that (s)he had the legal right, power and authority to
sign said owner’s name hereto as his/her attorney in fact.
Authorized Agent (signature)
Subscribed and sworn to before me, this _____ day of ________________, 20 ___, to certify which witness
my hand and seal of office.
NOTARY PUBLIC, MIDLAND COUNTY, TEXAS