2016-01-22_REVISION - M1986102

• Permit No: M1986102
• IBM Index Class Name: REVISION
• Doc Date: 1/22/2016
• Doc Name: Application AM01
• From: Dan Collins / Collins-More-head, LLC
• To: DRMS
• Type & Sequence: AM1
• Email Name: LJW
• Email Name: GRM
• Media Type: D
• Archive: No

NOTARY FOR STRUCTURE OWNER
ACKNOWLEGED BY:
1
Structure OwnerCollins-Morehead LLC Name Datiiel L. Collins
Date Title Managing Partner
STATE OF )
COUNTY OF •
) ss.
The foregoing was acknowledged before me this day of
as • , of
Notary Public
,20 ,by
My Commission Expires:
0 :',f,"0: "• t.',.."; ',IT:f
f-'!.-: . ' ': ‘. : ' : 0•..:: • „:
i sT,,.--.-... : f: i• - *.ro
1 -.7.-0...-) --.0C--;/
' MY Cri,,, -1....:::',...,: f.IX. il-', *:;'• v2, 14./9.017