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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 ) Sonailne of ‘Applicant/Petitioner ALISSQ Lachinag Print name of Applicant/Petitioner State of New York; County of Erie On the J day ofApea:( inthe year 202% 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 purpose rein one, Se Public ae (Notary stamp) TESSANDRA MOSIER Notary Public - State of New York No. G1MO6445682 Qualifted in Cattaraugus County Miy CSommissien EERIE 12/27/2026 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