AFFIDAVIT

OF ADDRESS CHANGE

The undersigned, having duly sworn, hereby deposes and says as follows:

1. I am a resident of Tooele County, State of Utah, over the age of twenty-one years and in all respects competent to testify to the matters contained herein.

2. I am currently employed as

and authorized by

3. I am familiar with the certain (plat or subdivision, entry #) recorded in the Tooele County Recorder’s Office.

4. The recorded plat lists the address for (Lot #) as (address)

5. (Reason for change)

Therefore the address for (Lot # and subdivision) is hereby certified and amended in the Official County Records to reflect

Lot# County Parcel # Old Address New Address

__________________________________ _____________________

Representative for Governing body Date

ACKNOWLEDGMENT

(Use appropriate acknowledgement for entity or individual executing this document)