Name of owner: ______ | |||
Owner's telephone number and mailing address: ______ | |||
If signer is different from owner: | |||
Name of signer: ______ | |||
State basis of legal authority to sign: ______ | |||
Signer's telephone number and mailing address: ______ | |||
If the owner is an individual, state if owner is single or married: _____ | |||
If owner is not an individual, state what type of entity: ______ | |||
Map and parcel number and assessed value of each tract of real property within the proposed district owned: ______ | |||
By executing this petition, the undersigned represents and warrants that he or she is authorized to execute this petition on behalf of the property owner named immediately above | |||
__________________ | __________________ | ||
Signature of person | Date | ||
signing for owner | |||
STATE OF MISSOURI | ) | ||
) ss. | |||
COUNTY OF ______ | ) | ||
Before me personally appeared ______, to me personally known to be the individual described in and who executed the foregoing instrument. | |||
WITNESS my hand and official seal this ______ day of ______ (month), ______ (year). | |||
______________________________ | |||
Notary Public | |||
My Commission Expires: ______; and |
§ 67.1421, RSMo