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• <br />(AGENT ACKNOWLEDGEMENT STATEMENT: <br />?- (? k 17$ ' <br />acknowledge that I am the rightful owner of the property <br />and hereby authorize 159AZf A$)Z 1?;(O - to serve as my agent #o the this <br />application and to work with the Responsible Official on my behalf during the <br />subdivision platting process. <br />Signature of Property Owner: , <br />Printed Name-A )A-J," C)+ W '4,. ,„ Date: _Ep ,f Q ° <br />of Agent: <br />• <br />Printed blame: Ag AtfzqA ,Date: il? <br />67tt :!;', a I <br /> <br /> <br />0