SAMPLE FORM FOR CORRECTIONS TO SURVEYS

STATE OF (enter State of notary) )
) ss                 AFFIDAVIT OF CORRECTION
COUNTY OF (enter County of notary) )

I, (enter surveyor's name), P.L.S. No. (enter registration number), being duly sworn, depose and say that I am the surveyor who surveyed the property as depicted and filed on survey number (enter survey number), Yamhill County Survey Records.

The following correction(s) to said survey (is/are) necessary and (is/are) as follows:

1.
2.

The present fee owner(s) of the property materially affected by this affidavit (is/are) as follows:

1.
2.

(legible stamp & signature of surveyor) (enter business name) _________________
Expiration date: (enter business address) _______________
(enter date), 200
NOTARY CERTIFICATE

Signed and sworn to before me on (enter date), 200X by (enter name of surveyor).

(enter signature of notary)_____________________
Notary Public for the State of (enter State of notary)

My commission expires (enter expiration date). (legible stamp of notary)

STATE OF OREGON
)
) ss
COUNTY OF YAMHILL )

I, Dan E. Linscheid, Yamhill County Surveyor, do hereby certify that said Affidavit of Correction for survey number (enter survey number) has been examined by me and that it complies with O.R.S. 209.

Approved _________________________, 200X.
______________________________________
Dan E. Linscheid, Yamhill County Surveyor

 

Rev. 1/11/00