Proof of Mailing Packet to West Orange

Township Of West Orange FORM PH-4Z Planning Board TOWNSHIP OF WEST ORANGE Application No. Pb-a ° Filed STATE OF NEW JERSEY COUNTY OF £ 7" y Amoahene | U wa" A ie of full age, being duly sworn according to law, depose and says, that (she resides at 43, Ede wood Aveviie in the Municipality of WES+ OV County of ES3°X and State of \\ UU J-€ fos that (s)he is the applicant in a proceeding before the Planning Board of West Orange Township, New Jersey being an (appeal or) application under the Zoning Ordinance, and which has the application No.. 2\ (0-0 | and relates to premises: (Name) (Location) Block #125 , Lot # Bu )! that on Apal (5 200% (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 tg the attached lists, and in the manner indicated thereon. ce ADM I, 20a Sworn to and Subscribed before me = Fs thisAQnicday of, fpr) AV. _— <2 —_pnnons. sricuano A Notary Public of New Jersey My Commission Expires January 2, 2029 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 & Awards\PH-FORMS\PH4Z.doc