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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 Applicané/Pétitioner Kober Lb. EA tus Print name of Applicant/Petitioner State of New York; County of Erie On the/i7L. day oft Z inthe year7OZ( 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 acknowledged to me that he/she/they executed the same for the purposes therein stated. NotankPétbtic SS sare é OFNEW YORK". % Notary stamg) = ; NOTARYPUBLIC: 3 otary stam to! Qualified j : 7 i ie » Erie count :§ 3 GO", otvinododzg MVS %%," Ors a iylgetres, / a ey e x Minh EXE 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