PERMFILE58825

• Permit No: M1992066
• IBM Index Class Name: Permit File
• Doc Date: 6/4/1992
• Doc Name: REVIEW WORKSHEET CHECKLIST
• Media Type: D
• Archive: No

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4. I.understand that statements in the application are being made under penalty
of penury and that false statements made herein are punishable as' a Class 1
misdemeanor pursuant to Section 18-8-503, C.R.S.
Signed and dated this L day of ~(,troC ~ ~
i~ C tZC Cis ~.~s~'Q c)zt'l a o 1 I l n1C ~ b ~ y A ~vt F ~l ~C~G ~G~T~' • -:'
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Applicant/Operator If Corporation Attest'(Seai)_:=;~~
By: ~ fJ~ ~~ By:
Title: ~~i-SI1~~T1 i

Secretary or E~gtlivalent
Town/City/County Clerk
State of CD~6IZ,4DO )
) ss.
County of ~OI,LTT )
The foregoing ilIllnstrument was acknowledged before me this 3"--°day of ~un1E ~94Z
by F2ED A. VUCKE~S ds ~K~S/DEn1T Of ~IdCkE~s ~NSTRU~-7/a~1,/Al<
J 8.4 YAc+rvA NG«C-Gn-TES
C,~ C-.
Notar ublic
C04/92) 2823E
My Commisslon Expires
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