2016-12-23_REVISION - M1981207

• Permit No: M1981207
• IBM Index Class Name: REVISION
• Doc Date: 12/23/2016
• Doc Name: Request For Succession Of Operator
• From: Western Slope Minerals
• To: DRMS
• Email Name: ACY
• Media Type: D
• Archive: No

NOTARY FOR STRUCTURE OWNER
ACKNOWLEGED BY:
Structure Owner w [,r�� S ^'���" Name
Date k 2 '1, Title CT�
STATE OF Cv I--, y )
�, ) ) ss.
COUNTY OF (r am c,(�'n
The foregoing was acknowledged before me this day of � , 20 Aso, by
Sic*.-, 1'44/c/ as L1 cr of f 5��� lvtw 'was
My Commission Expires: /O//,p/a zc,
Notary Public
TIMOTHY OLK
Notary Public
State of Colorado
Notary ID#201 64038408
My Commission Ex Tres 10-06-2020