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V. SIGNATURES (This application must be signed by the applicant/petitioner. |f the applicant is not the owner of the property, a separate owner authorization form must be submitted — see pg. 5 ) 4 TL Signature/of Applicant/Petitioner PAs DS. CRE HLT Print name of Applicant/Petitioner State of New York; County of Erie On thezggday of 4pr-Zin the year2@24@ 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 oses therein stated. /(‘ Notary Public fe JEANNE H VIGER Notary Public - State of New York (Notary stamp) No. 0110040429 Qualified in Erie County My Commission Expires 08/12/2029 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