Text · page 3 of 17
This document was a scan. Its text was produced by character recognition and may contain errors; check the original for exact wording.
V. SIGNATURES (This application must be signed by the applicant/petitioner. If the applicant is not the owner of the property, a separate owner authorization form must be submitted — see pg. 5) Signature of Applicant/Petitioner “Thom AS KeAscict Print name of Applicant/Petitioner State of New York; County of Erie On the Alpday of Sept in the year ZOZhefore me, the above individual appeared, personally known to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and DOROTHY BAILEY Reg #01BA0023544 Notary Ntéarypjublic, State of New York ( Qualified in Erie County ze Commission Expires April 15, 20_4© Office Use Only: Date received: 4 // [20/; 2925 Receipt #:,_ 7/3 YSF Application reviewed by: ALL ECDP ZR-1 form sent to EC: Hearing publication date: PREVIOUS APPEAL(S): A previous appeal to the Zoning Board of Appeals ( ) has ( ) has not been made with respect to this property. Previous appeals: Date: Type of Appeal: Granted Denied Date: Type of Appeal: Granted Denied