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81/15/2884 89:24 5414855G81 LARSON ELLIKER CPA PAGE 83/83 <br /> <br />Seht By: Law Office ol= ~lll Kio~ } 541.343-8702; Jan.15-( !2:01PM; Page 3/3 <br /> <br /> Written Statement Required for n Proposed Text Change <br /> <br /> A written example of'the proposcd text chan~e, Thi~ should be specific and site thc page(s) th~ change ~ppllcs <br /> to. <br /> <br /> lnformstlon Required for a Proposed Plan Diagram Change <br /> <br /> A map iwdicating the propcrty i~cluded in die request and adjacent streets and <br /> <br /> Avi. cini~ map inditers ~e general ~ca of the amendment ~d nllowin~ easy ~d.cmi fication of thc pmpe~. <br /> A map indica,tin8 thc ex[sting plan di~sram bo~dades and thc propos~ plan d[aBram boundaries, <br /> By signing~ the undersigned certifie~ that he/she bas read and understood the ~ubmlttal requirements outlined, <br /> and that he/she understands that omission of any listed item may c~use delay in processing this appltcnlion. <br /> (We) the undersigned acknowledge that the information suppli~ in this application <br /> the be~t of my (our) knowledge. <br /> <br /> PROPERTY <br /> <br /> Note: Please attach the namc~ phone number, add~ess, and signature of any <br /> additional <br /> owne~ <br /> the <br /> property. <br /> <br /> A.PPLICANT~S REPRESENTATIVE <br /> <br /> City/State/Zip: ~O~¢ ~ ~ 3 ~q~ <br /> <br /> R. cfin¢lllent Plan A.mendmcnt Date last revised: July 2, 2002 Page 2 of.~ <br /> <br /> <br />