Laserfiche WebLink
SIGNED, SEALED AND DATED this c2 Z day of "_P , 1 a a d <br /> �J,6 t.Ir 411A,,1_3 <br /> Operator (SEAL) <br /> By: <br /> Title: N, K,- <br /> NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT <br /> STATE OF t-1U,1 � YkU TIFFANY SECREST <br /> _ ) ss.: `1OTARY PUBLIC <br /> COUNTY OF (�,�}IV lk L>SC=� ) " tTF OP COLORADO <br /> e,'IOTARY lu 20184047213 <br /> Y GUMMiSSlON EXPIRES DECEMBER 11,2022 <br /> The foregoing instrument was acknowledged before me this day of Q�MAC'Lv4 , Ly Zy, <br /> by VL.L WL-e- V as UU 1 a)YU V 11&V+yu Y of �!'�2 i tyLt-y 2 c Vic IrLe s C`L <br /> Notary Publi�.4 AA <br /> My Commission Expires l 2 it I Z 0 2-Z <br /> STATE OF COLORADO <br /> DEPARTMENT OF NATURAL RESOURCES <br /> MINED LAND RECLAMATION BOARD <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> By: Date Executed: <br /> Division Director <br /> Rev.05/12 <br /> - 13 - <br />