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DpH Form No. 788 ~ PIT~DENTIFICATIDN <br />The owner hereby warrants that he has good title to the above described premises, that he <br />has the lawful right to grant this Option, and that he agrees to hold the Department <br />harmless from any and all claims from others asserting any interest in the subject land. <br />ATE DEPARTMENT OF HIGHWAYS <br />IVISION OF HIGHWAYS <br />STATE OF COLORADO <br />(Signature <br />H. W. 'rlalters <br />(Type Name <br />District Materials Engineer <br />Title) <br />*.~ <br />(Mortgagee <br />Signature <br />(Type Name) <br />• (Address) <br />*+~ <br />STATE OF COLORADO ) <br />ss. <br />County of Fremont ) <br />The foregoing instrument was acknowledged <br />before me this 1 day of December , <br />19 80 by H.W-C~alters , and <br />Edward J. Tezak Jr. and Beverly Tezak <br />Witness my hand and official seal. <br />My commission.expires , 19~ <br />.- f . <br />r <br />- ~~"-~` No ry P lic <br />- - **> <br />DIST.RI_BIAi ON`c <br />Original - Dist. Matls. Engr. (For Recording) <br />1 - Each Owner <br />1 - District Engineer <br />Design Engineer <br />Dist. Const. Engr. <br />- Dist. Maint. Engr. (Maint. Pits) <br />1 - Each Holder of Mortgagee Deed <br />OWNER(S) <br />By <br />(Si natur <br />Edward J. Tezak Jr. <br />(Type Name <br />By ~ <br />ignatu <br />Beve ly Tezak <br />(Type Name <br />Page 3 of 3 <br />