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Resident or Residents (all sign below) <br />—CityofFverett, a <br />icipal-corporation---- <br />OFFTO FORM <br />OFFICEICE OF OF THE CITY ATTORNEY <br />Mat <br />rin mihehaijo/owner) <br />Na '';", addre%Catorservice (It applicable] <br />Date Corm is filled out (scone as on top of page 1) <br />01/05/2023 <br />Attest: <br />St: to of Washington <br />County of <br />I certify that ( know or have sail-stactory evidence that <br />is/are the persons) who appeared before me and acknowledged that <br />he/she/they signed this instrument, and acknowledged it to be his/ <br />her/their free and voluntary act for the uses and purposes mentioned <br />in the instrument <br />Dated My Cumin ssion Expires <br />Printed Name of Notary P„ iiIC <br />Signature or Rotary Public <br />Note Snlnatuie,r,jollpnrneNmuubrWW1 ,.;edlJlcuseISIP!MOrethurlunevear <br />(ilc< o/oer spur e for notary ,Yuma, seal) <br />SPECIAL PROVISIONS (CONTINUED FROM PAGE 2). <br /><i 2022 Natnorai Apartment Acsn<ratlo❑ re <br />riasnu)rmn/Nano❑7l Ararti tn: A,ew n -u �)Ifnn-Lin ik,tole- t2_ Page9,�t,i <br />