that: Name \ I. I am the (check one) n Record title owner (fee simple) EOther (specify) of the real property described as Parcel No(s) 1Q mod oaer Pt Estate G cee-a- Aarneb Cc Quarter G A dZej i 1OOC Island 'St- Ln OYY1C4 2. I have the irrevocable approvals, permission, or power of attorney f