EXTERIOR MONUMENTATION AFFIDAVIT I, Error! Reference source not found., Error! Reference source not found., being first duly sworn, do hereby say that in accordance with O.R.S. 92.070, I have correctly surveyed and marked with proper monuments, the exterior corner as indicated on the original plat of SUBDIVISION NAME as recorded in Volume , Page , Book of Town Plats for Polk County, Oregon. Error! Reference source not found., Error! Reference source not found. STATE OF OREGON ) ss. ) ) County of This instrument was acknowledged before me on Error! Reference source not found.. , 20 , by Notary Public—State of Oregon My commission expires: CITY SURVEYOR APPROVAL Approved this day of , 20 , in accordance with O.R.S. 92.070(4). Salem City Surveyor By COUNTY SURVEYOR APPROVAL Approved this day of , 20 , in accordance with O.R.S. 92.070(4). Polk County Surveyor By \\ALLCITY\COMMON\TEMPLATE\PUBLICWORKS\VALL\_REAL PROPERTY\EXTERIOR MONUMENT AFFIDAVIT POLK_F.DOTX After recording, return to: Polk County Surveyor’s Office 820 Southwest Ash Street Dallas OR 97338