Item 3D: Resolution 5083 Annexing Land to the City of Eugene (River Ridge Golf Complex - A 12-6)

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Attachment C - Application Materials By signing, the undersigned certifies that he /she has read and understood the submittal requirements outlined, and that he /she understands that omission of any listed item may cause delay in processing the application. I (We), the undersigned, acknowledge that the information supplied in this application is complete and accurate to the best of my (our) knowledge. PROPERTY OWNER OF TAX LOT: 7 C6' )U�' Name (print): Address: Email: City /State /Zip: Phone: Fax: i Signature: Date: PROPERTY OWNER OF TAX LOT: Name (print): Address: Email: City /State /Zip: Phone: Fax: Signature: Date: PROPERTY OWNER OF TAX LOT: Name (print): Address: Email: City /State /Zip: Phone: Fax: Signature: Date: SURVEYOR: Name (print): Company /Organization: M b I A/C V N 6-- Address: u Annexation Last Revised May, 2009 Page 3 of 4 Application Form