Oregon Affidavit of Correction (Survey) Form

AFFIDAVIT OF CORRECTION (Survey) I, ____________, P.L.S. No._____________, being duly sworn, depose and say that I am the surveyor who surveyed the property as depicted and filed as survey number _____________ in Polk 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: (List names of affected owners)

(Legible surveyor stamp)

(Surveyor's Name) (Surveyor or Business Name & Address)

Renewal date: _____________

NOTARY CERTIFICATE STATE OF Oregon

) ) ss )

COUNTY OF Polk

Signed and sworn to before me on this _____ day of __________________, _____, by _____________.

_________________________________ Notary Public for the State of Oregon

(notary stamp)

Approval I, Eric Berry, Polk County Surveyor, do hereby certify that said Affidavit of Correction for CS (_____________) has been examined by me and that it complies with requirements of ORS 209.

_______________________________ Eric Berry, County Surveyor , 20 _ . Date