2016-06-30_REVISION - M2008078

• Permit No: M2008078
• IBM Index Class Name: Revision
• Doc Date: 6/30/2016
• Doc Name: Request For Succession Of Operator
• From: Jay Nielson
• To: DRMS
• Type & Sequence: SO3
• Email Name: AME
• Email Name: WHE
• Media Type: D
• Archive: No

NOTARY FOR STRUCTURE OWNER
ACKNOWLEGED BY:
Structure Owner".(4 [41 y PaJA3cr Name 40jtSSjA _ #014(itk-
Date /`t(,(A _���._44& Title C gape/
STATE OF
6�mdb )
ss.
COUNTY OFIT`n jd ,�j� }
e ('oregoingwas acknowledged efore me thislk.Aday of_ u,�F , 20/(�, b
tct2>✓h____ as in frndtytf _ of friar lxjh,� dwvu
My Commission Expires:
tart' Ptibli
LLALA J, OWEN
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 20034008485
MY COMMISSION EXPIRES MARCH 11,2019