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PERMFILE41561
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PERMFILE41561
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Entry Properties
Last modified
8/24/2016 10:44:13 PM
Creation date
11/20/2007 10:49:20 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1994113
IBM Index Class Name
Permit File
Doc Date
11/10/1994
Doc Name
RECLAMATION PERMIT APPLICATION FORM
Media Type
D
Archive
No
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<br />-5- <br />4. I.understand that statements 1n the application are being made under penalty <br />of perjury and that false statements made herein are punishable as' a Class 1 <br />misdemeanor pursuant to Section 18-5-503, C.R.S. <br />Signed and dated this ~~ day of /~'! ~' '~ \`_= ~"`: '-~~ <br />' 1_~~\~ J <br />.~ ti <br />H, ~ i <br />Appllcan /Operator <br />By: <br />Title <br />~ .l ~ ~ _ <br />_ ~ _ <br />+ _ / ^V .• <br />If Corporat~i°on A~tt-est (Sea9•)~. ~ ~- _ ,,' <br />By: ~~s~ <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ololgd0 ) <br />AA~~ ) ss. <br />County of a~ P~~ ) <br />The forego//ing Instrument was ackno edged bef re me this ~ day of v v 9l <br />by SCof]`Smir`i as /lSi~U Ownaf' of a ~1 P/! l.~pst <br />No y Pubilc <br />My Commission Expires: O ~~~~/10 <br />(04/92) 2823E <br />:., -. <br />
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