P. H. # _____________ Owner's Sworn-to-Consent Permitting Tenant to File for a Hearing (Individual) I, ______________________________, being first duly sworn, do say that I am the Owner of the property legally described below and which is the subject of the proposed hearing and I hereby grant consent to _______________________________________________, as Tenant to file this application for a public hearing. Legal Description: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ WITNESSES: __________________________________ Signature ___________________________________ Individual Signature __________________________________ Print Name __________________________________ Signature ___________________________________ Print Name Address: ___________________________________ __________________________________ ___________________________________ ___________________________________ Print Name STATE OF ________________ COUNTY OF ______________ The foregoing instrument was acknowledged before me by ___________________________, who is personally known to me or has produced ___________________________, as identification. Witness my signature and official seal this _____ day of ______________________, _____, in the County and State aforesaid. ____________________________________ Notary Public-State of __________________ My Commission Expires: ____________________________________ Print Name American LegalNet, Inc. www.FormsWorkflow.com