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---- ---- ' - - � ----1 <br /> ' COLORADO DIVISION OF m � <br /> - ��E��UR��G � unemmomy <br /> Iv,mNo' <br /> DEPARTMENT OF NATURAL RESOURCES <br /> GVV�'/1 1313 Sherman Si . Ste 821. Denver CODO203 <br /> 08120/6 (303)066-3581 <br /> stale <br /> - -' - CHANGE IN OWNER NA&0E/HNAKL|Y4G ADDRESS <br /> � — ---------'' ---- --- ��� | <br /> PRIOR no COMPLETING THIS FORM,SEE INSTRUCTIONS ow REVERSE SIDE <br /> /wcowpusrp.POOR uuAL/r,.on ILLEGIBLE FORMS CANNOT ae PROCESSED AND WILL osRETURNEDENGI <br /> � . <br /> 0 <br /> mooe a�/rvswnn� w <br /> | moire{s) <br /> / <br /> ' Iyla^/mgAud'omx .13/42W_59,nAve__ <br /> City,St zr' - <br /> � Phone, (��L.>'n�_-���' �mvn/ | <br /> '' ----- ---' ------- -------��� <br /> Well Permit � <br /> mumw�,��� 29 mo <br /> *pntwum Case Number(o,^"~.):_______.. <br /> �6 I����QAl!�N' County ��^ <br /> La -__- �_____ Well Name o,w(op*onu') ^m <br /> � - - � Q�' State Zip <br /> um�— *uu esv mvvm/Lo,"oon <br /> cpeu if weli address is^woev*owner's/�tinqouumoa | <br /> � N5 1mo'I,e ���_ 1g, S*o 2B _' .To~namp�iV_ 2N n,FlS. Range _LI.0_ RE m(Ew lNM,P,M pm <br /> 2302 P. morn <br /> !Iwmn5 ux° 2000 pt from[jJEor[]** Line. <br /> ayouw~ioo Name<�xvo."L,iiUIe/ ___ ----_____.______ ____ uu � Block -_' Fi:ngmwv <br /> mo/� xr�q,mxo°vu,' *cpwn^nau�omw/.o|aw�.use pm.owo GWS�z. _ <br /> . <br /> '----- ' —' -- <br /> /(wgusm^'�**that-nm(rea�)reow^*(a) mec above, w�wmeoon�p�mmms�=n�,mom*uovv�v . <br /> o`umu^that they,ire tn°I^aly(ou'Ixnow|eoov 37-90-143 <br /> � ' ��mm --�' '--rp���pnn�o`o�»"u.'swo"m&Tme ate <br /> � <br /> '---- --------- ' '------- -------- -----' --��� <br /> owner ofthisovell permit in',omplete and,�,,his foimva��enl*��or���m',attol 0100� <br /> n� ���� <br /> . �ease allow 4 too-weexovvpruxe-oyogu/v'mhvm Txc�yne you can v.°wo,nf/m`^vanceoxedunu/mc/xnx � <br /> '- --- ignatvm�Dn�st�/.^u'cutesvr��E�cuo��C��o.''O*** wamoun'u"/mao.ng^o*emy i <br /> | <br /> For Sfallvsec-11y <br /> �/—y _7 | <br /> �. ' <br /> oa*e � <br /> snx <br />