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CERTIFICATION
APPLICANT: I hereby certify that this application is accurate and complete to the best of my
knowledge.
Applicant's Signature: -
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Date: l \ / t'"L { 1.C, l:5":
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OWNER: (if different from applicant, and if owner concurs in application): I have read and
familiarized myself with this application and do hereby consent to its submission and processing.
Owner's Signature: _ _ _ _ _ _ _ __ _ _ _ __ _ Date:
- - - - - -- -
For additional application information please contact the Village Clerk's Office
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