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Thomas B. Quaw Square ▪ 91 E. Central ▪ Belgrade, MT 59714 Phone: (406) 388-3560 Annexation Petition Supplemental Information Form Applicant Contact Information: 1. Property Owner Name: Address: City: State: Zip: Phone: Email: 2. Preparer/Agent Name: Address: City: State: Zip: Phone: Email: Gordon & Julia Hardaway 5650 Jackrabbit Lane Belgrade MT 59714 [PHONE REDACTED] [EMAIL REDACTED] Headwaters Engineering, Garrett Schultz, P.E. 190 Lane Bozeman MT 59718 [PHONE REDACTED] [EMAIL REDACTED] ---PAGE BREAK--- Thomas B. Quaw Square ▪ 91 E. Central ▪ Belgrade, MT 59714 Phone: (406) 388-3560 Site Information: 3. Location (Legal): 4. Geocode 06 5. Area (Acres): 6. Zoned: Yes ☐ No ☐ a. If Yes, Zoning District: 7. Description of Existing Structures: Elements Checklist ☐Petition ☐Location Exhibit ☐Narrative Description of Plans for the Site If Site is NOT Zoned ☐Zone Map Amendment Application (including all requirements) ☐Certified List of Property Owners Within 300-feet of the Exterior Boundary of the Proposed Zone Change I (We*) hereby certify that the above information is true and correct to the best of my (our) knowledge. Applicant’s Printed Name Applicant’s Signature Date Property Owner’s Printed Name Property Owner’s Signature Date *If property has multiple owners, please inquire with Planning Department for required signature(s). S13, T01 S, R04 E, C.O.S. 668, PARCEL 5, ACRES 21.039, LESS HWRW 0903-13-2-02-80-0000 21.039 x xx x Garrett Schultz, P.E. Gordon & Julia Hardaway 12/01/2023 Commercial Corridor & Flex Employment Existing Equine Hospital, Veterinary Clinic, and offices.