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FEB-16-2012 12:01 From:CITY ATTORNEY 903 782 9721 To:Complete Care Clinic P.1/2 <br />APPLi.CAT.C4N FOR <br />DiSANNEXAT141Y <br />, <br />NAME 4F APPL1CAN"C(S): 1 rZ P C,-1. m Q1'X_ <br />MAILING A.ADRESS: <br />TE:LEPHONE NUMBER:S <br />VOTING D[STRICT NUM$ER: <br />~5 "o,S~~ ~ t~ <br />(this inforniat•ion may be abtuiiied thraugh the City Clerk of fhe CiCy of Pua'is) <br />VOTERREGiSTRATCON'Nl.JM13ER: ICC~i~~ l 1~t~J <br />ADDRESS OF PROI'ERTY;-VtISIs "S\ <br />UWe, the undcrsigned owner(s) of the aUove-described property, do hereby petition the <br />City of Faris to disaiil7ex i7iy/our prdperty for the fallowins r/eusons: <br />REQU.(REMENTS: Attach a camplete copy of the latest iiced ai' recard for the <br />Ahove-described propcrty evidencing ownership. This deecl must include a leba] description of <br />the property raquesteci co bc disttnnexed along witli u p.iat or a drawing indicnring tlle areA tc► be <br />disan.nexed. <br />]/We understand tl7at the Gity of :Pa.ris has no obliba.tion to disan:nex prapcrty cxcqpt as <br />may k+e rcquired by law. TMis applicatio:n must be completed, in its entirety, with all required <br />ttAChments. <br />Applictink(s) Sipiature Date <br />tcEB 16 rv.31> 43 <br />, ~ 63 <br />