2016-04-06_REVISION - M1987113 ‎(3)‎

• Permit No: M1987113
• IBM Index Class Name: Revision
• Doc Date: 4/6/2016
• Doc Name: Request TR03
• From: Bestway Concrete, Inc.
• To: DRMS
• Type & Sequence: TR3
• Email Name: MAC
• Email Name: WHE
• Media Type: D
• Archive: No

STATE OF COLORADO
COUNTY OF
On this day of 2015 before me, the undersigned notary public, personally
appeared as Manager of City and County of Broomfield, a Colorado
municipal corporation and county, personally known to me to he the person who subscribed to the
Foregoing instrument and acknowledged that he executed the same on behalf of said corporation and that
he was drily authorized to do so.
IN WITNESS THEREOF, 1 hereunto set my hand and official stamp.
NOTARY PUBLIC, STATh OF COLORADO
Print name.
My Commission expires: _.
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