Case Number____________
Number of Notices ________
Date Mailed _____________

I certify that this list includes all of the persons listed on the latest adopted Orange County Tax Roll as the legal owners (and if applicable occupants) of all parcels of land within five hundred (500) feet (and if application 100 feet) of the exterior boundaries of the attached legally described parcel of land which is the subject property of the above numbered application in accordance with the City of Dana Point Code. I also understand that if additional labels are required, then I shall provide them.

Note: 1. Use additional paper if necessary.

2. If information is in label form, then photocopies of the labels can be used in lieu of this Table.