dpnr 20260814 CZMJL0005 23 Liberty Mobile 2. L WD 5 permit application signed
GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DEVELOPMENT PERMIT APPLICATION FORM L&WD-5 PROOF OF LEGAL INTEREST AFFIDAVIT 3) ‘i I, Jo coc A Dot Qek (L\\wet tame \ve_ O SUI ue being duly sworn depose and say that: S Appliddnt(s)* {or John Doe of Entity Applicant) Lope ska WO Ve USUI Tic amis the (check one) (L arEntity/Applicant) Dlessee [JOther (specify) | _| CO Record title owner (fee simple) Of the real property described as Parcel No(s)___C2 > q- | Quarter Coral “pans Island + a 5 as son ocumentation for legal interest stated above (e.g. deed, lease, Estate Cato Wn *Applicant(s) is required to provide d etc.) ey from all other persons with a legal interest 2. [have the irrevocable approvals, permission, or power of attorn fully set forth in the exhibit in the property to undertake the work proposed in the permit application as more (s) attached hereto: asa Signaturg—— Date Signature Date Jota A2Wotoet ie Bivalt \\o Print Print The foregoing instrument was acknowledged before me this day of > »b Worcs. Ke Maioe Moly le > c Op. …
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GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DEVELOPMENT PERMIT APPLICATION FORM L&WD-5 PROOF OF LEGAL INTEREST AFFIDAVIT 3) ‘i I, Jo coc A Dot Qek (L\\wet tame \ve_ O SUI ue being duly sworn depose and say that: S Appliddnt(s)* {or John Doe of Entity Applicant) Lope ska WO Ve USUI Tic amis the (check one) (L arEntity/Applicant) Dlessee [JOther (specify) | _| CO Record title owner (fee simple) Of the real property described as Parcel No(s)___C2 > q- | Quarter Coral “pans Island + a 5 as son ocumentation for legal interest stated above (e.g. deed, lease, Estate Cato Wn *Applicant(s) is required to provide d etc.) ey from all other persons with a legal interest 2. [have the irrevocable approvals, permission, or power of attorn fully set forth in the exhibit in the property to undertake the work proposed in the permit application as more (s) attached hereto: asa Signaturg—— Date Signature Date Jota A2Wotoet ie Bivalt \\o Print Print The foregoing instrument was acknowledged before me this day of > »b Worcs. Ke Maioe Moly le > c Op. at Som QVav county a0 = ¥ (Name or e/Title of Entity) of PUL RNCO we ‘S os 7 My Commission expires Notary Public