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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 ) L | fi f Signature of Applicant/Petitioner Pup Lo LAELISS © Print name of Applicant/Petitioner State of New York; County of Erie On the olfiday ofhune. in the year 2©2oefore 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 (hat he/she/they executed the same DOROTHY BAILEY (Notary starag 01840023544 Notary Public, State of New York Qualified in Erie County Commission Expires April 15,Yond § Se ee em me en em mem ah A A A tS tt A ke nt tt St et Hk td yt ret st ee te ny ete Se es 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