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NEBRASKA <br />Good Life. Great Journey. <br />DEPARTMENT OF TRANSPORTATION <br />1, 7 -Pon o --i 17 jI)Q P4 J-vry <br />is true and accurate to the best of my knowledge: <br />201901 68 <br />STATE OF NEBRASKA <br />DEPARTMENT OF TRANSPORTATION <br />Affidavit <br />, the undersigned, swear or affirm that the following <br />1. I am the j tiara i 1 tvb m 4 )1I 13 fn— for kq yn r -rf PA -7 S , <br />(title) (name of organization) <br />organized in accordance with the laws of the State of 447:11P-- and/ or <br />lawfully operating in the State of Nebraska; and <br />2. In that capacity or by resolution of the <br />(governing body) <br />dated , I am authorized to sign any and all documentation on behalf <br />of the above named entity regarding the sale or use of property rights in general or specifically <br />with the State of Nebraska - Department of Transportation project as noted at the close of this page. <br />Dated this 14 day of ) D~'19 , 20 . <br />State of <br />N - <br />County of <br />ss <br />—1;11/11' <br />Signature <br />�I rY1 l Yh /f,. 91-�t --- <br />Print Name <br />Subscribed and sworn before me this 41-14 day of r Cir l ,200 . <br />State of Nebraska General Notary <br />KRYS, Al. DiiBAS <br />My Commission Expires <br />June 14, 2019 <br />Project No.: 30-4(162) <br />roject Name: In Grand Island Bridges (TK) <br />Control Number: 42776 <br />Tract No.: 5 <br />