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PERMFILE51991
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PERMFILE51991
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Entry Properties
Last modified
8/24/2016 10:55:55 PM
Creation date
11/20/2007 3:09:15 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M2004067
IBM Index Class Name
Permit File
Doc Date
11/21/2005
Doc Name
Exhibits 32-40
From
City of Black Hawk
To
DMG
Media Type
D
Archive
No
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11/09/2005 17: BB 3035023086 GILPIN C09~`TY PAGE 07(07 <br />Illllillllllllllll~lll IIIII111111INIlllll IIIII IIII III <br />.. .. _ .,_. ..._ - 7 ei D R 12S.0a D 0.00 _'__.. <br />NOTICE, A3 A MATTBR OP AECORD, Al® CLAIM OP DBCLARATION OP <br />STATOS BY RIGET OP SUHROGAION: TO WAOM IT MAY CONCERN AND <br />I HAVE READ THE CONTENTS HSRfi;N, AND TO I'FD3 HBST OP MY PRR30NAI. <br />KNOWLEDGE I DECLARE ON MY OWN THAT THE INFORMATION STATED, HHRBIN <br />I3 1RQE, CORABCT, COMPLETE AND NOT MISLEADING, i.e.; THE TR01H. <br />MY WORD I3 MY HOND APID MY HAND I3 <br />1d Tune ~nn9 <br />IDAY-MONTH-YHAR) PH <br />I,, Ph' Wn1F. THB AHOVE AUT06RAPH HY MY HAND, <br />DOES HE Y ACKNOWLEDGE AHO AFFIRM, r0 THE BEST OF MY ABILITY, <br />THAT THB ATTACHED 6 PAGES ARE A TRUE, ACCORATH AND COMPLETE <br />STATEh18NT OF FACTS SUPPORTING MY PDBLZC NOTICE, A9 A MA'1THR <br />OP RECORD, A18i CLAIM OF DBCLAEATION OP STATOS 8Y RSGHT OP <br />SUBROGATION: TO~NHOM TT MAY CONCERN <br />JUDICIAL NOTICE: The use of a Rotary is eo form only and is <br />for certification purposes Daly and is not to be construed as <br />submission to any foreign jurisdiction or local jurisdiction <br />and is NOT AN ACCOMMODATION and with all rights reserved. <br />The below Aff iant's Autograph verifies under Oath by Atfixmaeioa <br />that He is aware of the facts stated On these POUR pages that <br />are entitl efl: POBLIC NCY1'ICE, AS A MATTBR OP RBCDRD, AND CLAI17 <br />OP DBCLARATION OP STATOS BY RIGBT OP SUBROGATION: TO WHOM TS <br />MAY CONC®tN and that Be hae first band knowledge of the facts <br />herein staled. These facts are [rue, accurate and correct to <br />Che best Of His Fizst Haad knowledge. The Atfient knows the <br />penalties of parj ury and bearing false witaaes against His Fellow <br />men and this paragraph is a statement of fact, as My word is <br />My pond and M~y:~hand/autograph is My seal <br />DONH THIS ~:__ day of 44 ?Q c 2 <br />s Aut graph <br />county of ~e~~3Yt~tJ and a of ~' ~oAf~ <br />The above sentient man/woman personally appeared before me aad/or <br />identified to me by proper iflenii£ication, did autograph and <br />verify tha.preceding flocument entitled:"PDffiIC N7fICE, A3 A <br />MAT}ZGt...4p,. RHCORD, AMD CLAIM OP DBCLARATION OP STATOS BY RIGET <br />`~'~R~T~ON: TO WHOM IT MAY CONCBFtN <br />~.,`yC/ 1Jy0snr~ f~ c <br />~~ HaTaRY i~~ My commission expires Notary iic <br />„? PybLID ;'o ~~: Page Four of Pour.1 <br />~+ : o <br />i <br />. f OP COG Lam. <br />
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