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Attachment C - Application Materials <br />By signing, the undersigned certifies that he /she has read and understood the submittal requirements <br />outlined, and that he /she understands that omission of any listed item may cause delay in processing the <br />application. I (We), the undersigned, acknowledge that the information supplied in this application is <br />complete and accurate to the best of my (our) knowledge. <br />PROPERTY OWNER OF TAX LOT: / q <br />Name (print): �11r �l�� x xi) <br />Address: Email: <br />City /State /Zip: A Phone: Fax: <br />Signature: <br />Date: <br />PROPERTY OWNER OF TAX LOT: I ?X n 1 7-c I / I U Z, Zl t <br />Name (print): ;,kANtja- . L, ,C- 5 1> eig 0 P/ gTffy ,1 <br />Address: Email: <br />City /State / Zip: <br />Signature: <br />Phone: <br />Fax: <br />Date: <br />PROPERTY OWNER OF TAX LOT:- I U 7 <br />Name (print): U 1 b zi?r % e <br />Address: Email: <br />Annexation Last Revised May, 2009 Page 3 of 4 <br />Application Form r <br />