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SIGNATURE: <br /> The Applicant declares that all information provided on this form and submitted attachments are to the best <br /> of their knowledge true and complete. Furthermore,the applicant agrees to abide by the provisions listed on <br /> this form.and acknowledges that additional conditions,including consideration fees and bonding requirements, <br /> may be imposed. <br /> Jodi Schreiber �— <br /> eLjft Ti tie <br /> °i `'b''10d1 wwow j Ma 17,2022 <br /> Jodi Schreiber o.,,.�05.,,a, ,. � Y - _ <br /> .Signature Date <br /> Document is not valid without authorized signature of the Board of Land Commissioners. <br /> Once signed by an authorized representative of the Board,this application shall become the <br /> Temporary Access Agreement.All terms are binding on the applicant. <br /> FOR OFFICE USE ONLY:DATE(S)AUTHORIZED FOR TEMPORARY May 16, 2022 TO Aug 16, 2022 <br /> ACCESS CONSIDERATION(IF APPLICABLE) ENTER AMOUNT:S Zero <br /> ADDITIONAL CONDITIONS: <br /> ' - <br /> STA7r .AND BOARD SIGNATURE AROVAL DATE <br /> i <br /> IrftgyNMyfvfe-iirrmllAlgltkniion www,trustlands,state.co,us Rev.20210609 <br />