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Attachment C <br />By signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/she <br />understands that omission of any listed item may cause delay In processing the application, I (We), the undersigned, <br />acknowledge that the information supplied in this application is complete and accurate to the best of my (our) knowledge, <br />OWNER (Also the Applicant? [n Yes / LJ No): <br />Ruby E. Vonderheit Revocable <br />Name (print): Trwa Phone: (541)5544128; (54l)344-9472 <br />Address,: 3240 South Lois Lanc, <br />City/state/zip: Hugcne, OR 97405 <br />Signaturew <br />APPLICANT[D APPLICANT'S REPRESENTATIVE (Check one), <br />Name (print). Kirk and I,isa Vonderlicit <br />Co m pa ny/orga n izatio n <br />Address3240 South Lois Lane <br />City/'State/Zip: Fugene. OR 97405 E-mail (if applicable)! <br />Phone• (541) 554-4128,(541)3.4,,I-()472 Fax:. <br />Signature - <br />APPLICANT'S REPRESENTATIVE DESIGNATED CONTACT PERSON (Check all that apply). <br />Name (print): Wil harn I J, Sherlock <br />Company/Crganlzat�on: I futchinson Cox <br />Address: 540 Wilbunelle Street, Suite 4()0 <br />City/State/Zap. Engenc, OR 97401 E-mail (if applicable); lsherlock4cugene9tm com <br />Phone: (541168691fio Fax: <br />Si <br />wV_'V_weatQff LLz9_0VZP_h7n1?0q <br />Planning & Development . . ...... <br />Updated., March 2014 <br />Planning Dlvlsion <br />99 K 100„ Avenue, Fugere, OR 97401 <br />Phone: 541682,5377 oa E-mail: eugenepla n6ng@cu.e ugepe.or,us Page Z of 2 <br />