2017-05-17_GENERAL DOCUMENTS - M1981020

• Permit No: M1981020
• IBM Index Class Name: General Documents
• Doc Date: 5/17/2017
• Doc Name Note: Supplemental Page
• Doc Name: Agreement to Conduct Permitting by Electronic Means
• From: Indian Springs Ranch, LLP
• To: DRMS
• Email Name: TC1
• Media Type: D
• Archive: No

Agreement to Conduct Permitting by Electronic Means
Name of permittee representative desiring to
opt in to ePermit:
Title:
Name of permittee:
Signature:
ePermitting Administrator (if different from
representative signing agreement)
Email Address for ePermit Account:
,
Notarized Affidavit of Signature
STATE OF: }
COUNTY OF: ) ss.
�ev►r1a�
The foregoing instrument was acknowledged _
before me this � C3 day of by
(date) (moat (year)
as
(Name of permittee representative) (title)
of
F
AH RHULE
RY�-PUBL1C
F COLORADO
0 20154011505
n Expires i�J-25.2019
(seal)
My Commission expires:
(permittee)
Page 3 of 6
NO Y PUBLI