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By affixing my signature hereto, I certify that I am the owner, or am acting as the Owner's <br />authorized agent, and that the application and documents contained with this submittal are <br />complete and accurate to the best of my knowledge and abilities. lf your title report lists a <br />company, partnership or other owners, you must submit evidence that you are authorized to sign <br />on behalf of the entity or others that are listed. <br />lf you are an authorized representative you must submit an Agent Authorization Form. <br />Please attach additional signature sheets if there is more than one owner. <br />Under penalty of periury, I certify that the information, statements, answers above regarding <br />the subject application(sl are true and correct to the best of my knowledte and belief. <br />Signature:Date: <br />printed Name: Leslie Eastwood, General Manager, Samish lndian Nation <br />STATE OF WASHINGTON <br />COUNTY OF SKAGIT <br />I certify that I know or have satisfactory evidence that LA\li- A. EaolSo(is the <br />person who appeared before me, and said person acknowledged that he/she signed this instrument, <br />and acknowledged it as the free and voluntary act for the uses and purposes mentioned in this <br />instrument. <br />Given under my hand and official seal this d-1 day ot ,lu)rt ,20 7) <br />I{OTAT/ PIJBLrc <br />STAIEOFWASI-flNGTON <br />VMAN SUMMEBS <br />Lic. No. 90512 <br />MyAppdntmcrr Eehgg <br />At,GtJST N/3 <br />otary Public <br />NB <br />Master Land Use Permit Application <br />) <br />)ss. <br />Residins "t kul, l)A <br />My appointment exOires AUA. i"c +4 <br />Page 4 of 4