State
of
On this ____ day of _______________,
2002, came before me ______________,
a notary public in and for the State of
his oath
deposed and said as follows:
My name is _________________________. I am above the age of 21 years and
fully
competent in all respects to make this affidavit. I am familiar with property
owned by
Jerry Surber generally known as the Mosier Valley Motocross (3918
and uses,
and the extent of uses located on said property in 1977, the time of
annexation
of the property. Such structures, uses
and the extent of said uses at
such time
consisted of the following:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
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Further, affiant
sayeth naught.
_____________________________
Affiant
Subscribed and sworn to before me
this ___ day of __________________, 2002.
_____________________________
Notary
Public
My commission expires:
_____________________