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3330 SOUTH 1300 EAST Millcreek, Utah 84106 [PHONE REDACTED] Millcreek.us Proof of Primary Residence Affidavit Owner’s Name: Address: City: Zip: Date: Phone: Email: I hereby represent that I own the above identified residential property in Millcreek and that it is my PRIMARY RESIDENCE and personal habitation, and the single location to which I intend to return after being absent. Signature: Name Printed: Date: STATE OF UTAH ) ) SS COUNTY OF SALT LAKE ) On this day of 2020, personally appeared before me, who, acting as an authorized representative of Millcreek, acknowledged that he/she signed the above certificate and that the statements contained therein are true. Notary Public, Residing in Utah