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