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Town of Aurora Special Use Permit 575 Oakwood Avenue Application East Aurora, NY 14052 Owner Authorization www.townofaurora.com The undersigned, who is the owner of the premises know as: hereby authorizes. whom Ber MOdy Ng ham. ae to bring an application for a special use permit before the Town of Aurora Town Board for review and potential approval. The undersigned further permits the Town or its authorized representative(s) access to the property to review existing site conditions during the review process. “Pak ako a Duty, O71 20> Reals Owner (print) Date Owner (signature) STATE OF NEW YORK ) SS COUNTY OF ERIE ) On this 3 day of oly , 20 Ab, before me, the undersigned, a notary public in and for said state, personally appeared “Poseree Dut , personally known to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. fl show 1, 0 abe NOTAR _ MIC D.§ 9A Notary Public-~ CG) YP verlC STATE