Planning Division Application Form Page 3
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3SUPPLEMENTAL AUTHORIZATION FORM
(MUST BE NOTARIZED)
I, the undersigned owner of record of the real property described below, do hereby authorize
to act on my behalf and to fulfill other
requirements, including the right to make appeals on my behalf, as are required by the
provisions of Ordinance 635 (Zoning Ordinance of the City of Daly City) in connection with a
zoning application to the City for a
involving the
property, which is the subject of this authorization and which is described as:
Owner’s Signature
Date
Address
Telephone
If there is more than one property owner, each must sign an authorization form. All authorization
forms must be notarized within the past 90 days.
}
State of California
County of
On
, before me,
, Notary Public,
personally appeared,
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument
and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature of Notary Public
PLACE NOTARY SEAL ABOVE
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