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I101 SINGLE-FAMILY DWELLING AFFIDAVIT
211
i OWNERS NAME .P� ��MS
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MAILING ADDRESS . flit
j PROPERTY LOCATION A ' f:F--FALL,
TAX PARCEL NUMBER 39• I.2
STATEME
1, h4eAAQjM 4,1Z iWj"by declare that the dwelling situated on Town of Ithaca Tax Parcel No.
Owner
�Q ►J , known as s a strtxrture used exclusively as a containing one single-family
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Roi&MV. in conturw1ion with the Buttermilk Falls Bed anti Breakfast i1wrauon. Said operation consists of the utilvation of four,
t second tkxw guest bedrooms. each accommodating two individuals, for a maximum total of eight jut s. A lint floor IxJn 'm is used
�tTt!-DES tu)`'rH/LCa.*1 fC O1J 2.
i other part of ratbuildins. including the basement or cellar, will he utilized
r 1 'r'�in A st! BBB sills• 4 �Zi��s ( 'tiE• �CartAr'>c.
as a bedroom.
Ktf..f�o �b'rIq
1 further declare that I will notify the Town of Ithaca of any change in the situation described above: and that I hereby agree that
any person duly authorized by the Town of Ithaca. upon identirwatiom of�� eland a declaration of their purpose. shall have the
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right, on two days a(aki . to examine the owner'+ Propen and to enter upon and inspect the premises and to inquire into
the woe mw renal sows of any portion of the i rwiwe on said prJpiftli'. I understand that by signing this affidavit 1 maintain the right
to appear before the Town of Ithaca Zoning Board of Appeals in order to seek a change in the use of said property and the buildings
there".
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I certify, under penalty off pajtry. Mtn dw am s aMnMW are true and correct. `w
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Dale ' Owner pplicant/b q16 t ry i ac
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DMV Notary Public 1°
Ilohty P lift BtaNIQ of NW 10AI
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