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NOTARY FOR STRUCTURE OWNER <br />ACKNOWLEDGED BY: <br />Stricture Owner <br />Name4--D&tQ�07)�6e �l <br />(Print Name if Private or Name of Business) (Print Name if Representative of Owner) <br />Date _ L� D �!� �) 1 Title O <br />(Enter either Owner if Priv or Representative Title) <br />Signature of Owner or Representative <br />STATE OF COLORADO ) <br />) ss. <br />COUNTY OF EL PASO ) <br />The foregoing was acknowledged before me this _/ t A day o f N D II L j?`1 l' 201 g b <br />> Y <br />as ��' V of <br />(Signature Own4r) (Title if Business) <br />(Name if Business) <br />Notary Public My Commission Expires: C b 9 a,a <br />MICHAEL T WALSH <br />NOTARY PUBLIC <br />S'P'ATE OF COLORADO <br />MY COMMISSION EXPIRES- �i?� <br />Page 3 of 3 <br />