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By the Structure Owner: <br />ri4* i 4/4iir•V AM /lmils+i/t /Z. D/-/3' <br />By Structure Owner Date <br />State of Colorado ) <br />)ss <br />County ofheNit ) <br />The foregoing instrument was acknowledged before me this day/Lyof Xi 2p <br />byAssrsas ?LAa 1C' . /S�, <br />as /Nor a�.►f► -paorrsii; of <br />Adossr edownsa4r.don ofee/w Coorkmeti.v. c <br />(UJ) <br />otary Public <br />My Commission expires: D I/ S 11`D I b <br />Page 2 of 2 <br />