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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 ) Ne oni rnc — of Applicant/Petitioner Jay Prentice } Jace D ekee Print name of Applicant/Petitioner State of New York; County of Erie On the,2/ day onseptorth te ear Z02Z3pefore 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 acknowledg 4, to me that he/she/they executed the same esjdtherein leak N_Notary Rite starrer agen ms abana Gur: eReege owes tee ran N. anatoninaneen O05 o a: (Notary stamp) LINDAS. HODAK i hg nar ie net Couny York ie oC ualified in Erie Coun eae ‘a oe, SS Raia RANI RAG Rak Gain cite hai kintse co SUA 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