Laserfiche WebLink
(10 -08 -2009) <br />I HEREBY CERTIFY THAT THE FOREGOING REPRESENTATIONS AND ATTACHMENTS <br />ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. <br />. Raymond G. DuBois, Vice President & General Manager <br />(Printed Name) (Date) <br />(Signature <br />2. <br />(Printed Name) <br />3. <br />(Printed Name) <br />4. <br />(Printed Name) <br />(Signature) <br />(Signature) <br />(Signature) <br />(Date) <br />(Date) <br />(Date) <br />NOTE: SIGNATURES OF ALL PROPERTY OWNERS, AND THE AUTHORIZED <br />APPLICANT, REPRESENTATIVE AND /OR AGENT IS REQUIRED <br />(use space over as needed) <br />OTHER INFORMATION <br />(attach additional sheets as necessary) <br />Assessor's Tax Parcel Identification No(s) (PID), Attachment A <br />Received By: <br />Amount Received: $ <br />Date: <br />Check #: Receipt #: <br />Page 4 of 4 <br />