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V. SIGNATURES (This application must be signed by the applicant/petitioner. If the applicant is not the owner ofjthe property, a separate owner authorization form must be submitted — see pg. 5) Ay ram tle Signature of Applicant/Petitioner Werner Print name of Applicant/Petitioner State of New York; County of Erie On the” day of kilt, inthe year Zl 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 forthe purposes therein stated. \ ues Notary Public MELISSA M. DUNNING (Notary stamp) NOTARY PUBLIC, STATE OF NEW YORK Registration No. 01DU6113644 Qualified in Erie County iCommission Expires August 2,20 2 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