SAMPLE AFFIDAVIT OF INTERIOR MONUMENTATION State of Oregon County of ) )S.S. )
I, (Name) , P.L.S.# , being duly sworn, depose and say that in accordance with O.R.S. 92.070, I have correctly surveyed and marked with proper monuments, the interior , as recorded in Linn County Record corners as indicated on the plat of (Plat Name) Book of Plats in Volume , Page , Target Sheet recorded in Document Number (or MF Vol. , Pg. ), Linn County Deed Records, Linn County, Oregon. Said interior corners were set on (Date) .
(Surveyor Stamp)
Return to: (Name) (RPLS #) (Address)
Expiration Date:
NOTARY CERTIFICATE State of Oregon County of Be it known that on this day of , , before me, a Notary Public in and for the , to me personally known, State of (state) , personally appeared who being duly sworn did say that said Affidavit was signed and sealed by him and he did say said Affidavit to be a free act and deed.
NOTARY PUBLIC FOR STATE OF My Commission Expires:
STATE OF OREGON COUNTY OF LINN
) ) S.S. )
I, Charles W. Gibbs, Linn County Surveyor, do hereby certify that said Affidavit of Interior Monumentation for (Plat Name) has been examined by me on , 200 , and that it complies with O.R.S. 92.070.
Linn County Surveyor