01 PH 2Z Notary

Township Of West Orange FORM PH-4Z Zoning Board of Adjustment TOWNSHIP OF WEST ORANGE Application No, 2B-24-14 Filed STATE OF_New York COUNTY OF _Ueuy YoC Kk Joana Fa: of full age, being duly sworn according to law, deposes and says, that (s)he resides at _10 Shrumy in the Municipality of _West Orange County of and State of New Jersey that (s)he is the applicant in a proceeding before the Zoning Board of Adjustment of West Orange Township, New Jersey being an (appeal or) application under the Zoning Ordinance, and which has the application No. ZB-24-14 and relates to premises (Name) (Location) Block #176.07 Lot #30_, that on Mocch 27, 20 2g, (s)he gave written notice of the hearing on this application to each and all of the persons upon whom service must be heard, in the required form and according to the attached lists, and in the manner indicated thereon. Date of Serving Notice [Maa 21. OOS Sanat fn Applicant's Signature Sworn to and Subscribed before me RONA SHAVIT this 27” day of _Mocch 20 25° Notary Public - State of New York No. 01SH6209229 Qualified in Nassau County Commission Expires July 20, 2085 NOTE: Proof of service of notices required by statute must be filed and verified with board secretary at least two (2) days prior to meeting or case may be postponed. Attach list of all persons served. G:Forms & AwardsPH-FORMS\PH4Z.doc