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5. Executed on the date first written above. <br /> GRANTOR: Orphan Wells of Wiggins <br /> (SEAL) <br /> BY 1/i <br /> Signature <br /> Name _Sl V ? f if r, <br /> Title Pi.. S OY( v� <br /> Date / is-ph <br /> ATTEST: <br /> BY /4) f-: l� <br /> i nature <br /> Name / 4(A- -T (1/b-)r� <br /> Title - <br /> Date `7"— f— <br /> State of Colorado <br /> � <br /> n ) ss. <br /> County of 111 t()t'C�Ct y� ) <br /> The foregoing instrument was acknowledged before me on Q-10'Z..�-( lS , 2016, by <br /> 6(afritZ._. Pre(Name) as c �GZ. (Title)tand <br /> Wk l4WT h JO fS (Name) as V t C-e `PVdITitle) of the Orphan Wells of <br /> Wiggins, LLC. Witness my hand and official seal. <br /> Nntary Ohlir. <br /> PATRICIA CRITES <br /> My commission expires 4. c OfNOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 19934008901 <br /> MY COMMISSION EXPIRES AUGUST 2.2017 <br /> (Colorado Water Conservation Board will record Amendment to Deed of Trust with the County.) <br /> Appendix C to Amendment No. 1 <br /> Page 2 of 2 <br />