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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.obApplicant/Petitioner Aro Doevwa | Print name of Applicant/Petitioner State of New York; County of Erie On the q day of Decembty the yearZOZ5) before 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 cknowledged to me that he/she/they executed the same Notary Public Notary stamp) poROROTA*'BAILEY ” Pp)«Reg #01 840088544 ayciNotary Public, State‘of N¥@York Quatlifiedin Erne Count coMommissionExpices' Ape BaZS Office Use Only: Date received: api Receipt #: 7/3 532—~ Application reviewed by: CHA Ge 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