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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 of Applicant/Petitioner Let bite _SEPFES Print name of Applicant/Petitioner State of New York; County of Erie On the,0 bay of Harch in the year Np before me, the above ol) cay appeared, personally known to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she/they executed the same es therein stated. ~\ , "shen Wn ei Notary Public ANNA MARIA DOLINA (Notary stamp) NOTARY PUBLIC STATE OF NEW YORK ERIE COUNTY LIC. #401D00025397 COMM. EXP. 05/31/2028 Office Use Only: Date received: Receipt #: Application reviewed by: 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