HomeMy WebLinkAboutSUB201600137 Affidavit Family Division Plat 2016-10-23 NIWOle
'140,m17
v�Rci�u'
COUNTY OF ALBEMARLE
Department of Community Development
401 McIntire Road,Room 227
Charlottesville,Virginia 22902-4596
Phone(434)296-5832 Fax(434)972-4126
AFFIDAVIT
Verifying Family Relationship of Grantor to Grantee
I, 1110,..) lvl.soJ , (property owner/Grantor) hereby certify that the subdivision of Tax
Map B Parcel ki3A is a family subdivision in accordance with Sections 14-208, 14-211,and 14-212 of the
Albemarle County Subdivision Ordinance, and that the table below outlines the relationship of each Grantee to the
Grantor. I acknowledge,that I have read and understand Sections 14-208, 14-211,and 14-212 of the Albemarle
County Subdivision Ordinance which is attached to this affidavit.
Grantee(s) Relationship to grantor Parcel/Lot
���-tAAm. 1)NIJ --bAUJk—dre, .. Loi. A a.kx)A mss)
atItArLD
cz—m/46-
P operty Owner/GrantorSignature Date op.,•• •�
CA)61,50,0 c (11 (Y10 i . NOTARY'••,9�'.
• PUBLIC .
REG#7203005 S t
COMMONWEALTHZ+VIRGINIA : 0 MY COMMISSION
CITY/COUNTY OF ( .i.� - pc-Nay- ? '• 6/30/20EXPES : g`
20•;'x
The foregoing instrument was acknowledged before me this day of C i ,20 I(P
by N t 1 SO r'1 •Mo(rt S Grantor.
(4- Al 1i.o,-) M• Mcr-ri s
My Commission Expires: C,Q J3O/ QQ �t�'V l�.J�•�1�, > ,�� {�
Notary Public " _ 0 3 005-
2/28/08
O2/28/08 Page 1 of 3
1
File: Original to Subdivision file SUB