(Space reserved for Clerk) ___________________________________________________________________________ OWNERSHIP AFFIDAVIT FOR CORPORATION STATE OF ________________________ Public Hearing No. ________________________ COUNTY OF ______________________ Before me, the undersigned authority, personally appeared _________________________________ and _______________________________, hereinafter the Affiant(s), who being first duly sworn by me, on oath, deposes and says: 1. Affiant is the president, vice-president or CEO of the __________________________ Corporation, with the following address: _________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 2. The Corporation owns the property, which is the subject of the proposed hearing. 3. The subject property is legally described as: ____________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 4. Affiant is legally authorized to file this application for public hearing. 5. Affiant understands this affidavit is subject to the penalties of law for perjury and the possibility of voiding of any zoning granted at public hearing. Witnesses: ___________________________________ __________________________________ Signature Affiant's signature ___________________________________ __________________________________ Print Name Print Name ___________________________________ Signature ___________________________________ Print Name [f\:form\Affidavit Ownership Corporation.doc (5/13/04) Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com (Space reserved for Clerk) ___________________________________________________________________________ Sworn to and subscribed before me on the ______ day of ___________________, _________. Affiant is personally known to me or has produced ___________________________________ as identification. __________________________________ Notary Public Signature __________________________________ Print Name State of ______________________________ My Commission Expires: ________________ [f\:form\Affidavit Ownership Corporation.doc (5/13/04) Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com