Laserfiche WebLink
SIGNED, SEALED AND DATED this day of Tt"-( <br /> Operator Q (SEAL) <br /> By: 1 <br /> Title: ;ar Vic e flZ�i�c rt�- <br /> NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT <br /> STATE OF CQ LUO_0 U ) <br /> ) ss.: <br /> COUNTY OF V M 5 ) <br /> The foregoing instrument was acknowledged before me this day of , Do kt) <br /> by-:21oQ,e tLi . C-a t_L1 S as of t��Y�P s �nSTPo c�snti�. <br /> r <br /> ERINE ANN HARRISON Notary PublicNOTARY PUBLIC `''—��8y\ � l\, .S- �— <br /> TATE OF COLORADO My Commission ExpiresTARY ID: 19974014716 <br /> W COMMISSION EXPIRES AUGUST 21,2017 <br /> STATE LORADO <br /> DEPARTMENT OF NATURAL RESOURCES <br /> MINED LAND RECLAMATION BOARD <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> By: Date Executed: <br /> Division Director <br /> Rev.05/12 <br /> - 3 - <br />