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AFFIUl:\'17 OF 11~TEF:EST 0'..'.:EP.~ <br />Y.INERAI.S A1:Dl0R SUbS1~F~ACE <br />• Application No. <br />Subject Property <br />STATE OF COLOFADO ) <br />ss. <br />COUNTY OF WELD ) <br />THE UNDERSIGNED, being first duly sworn, states that to the best of his <br />or her knovledge the attached list is a true and accurate list of the names <br />and addresses of all mineral owners and lesses of mineral owners on or under <br />[he parcel of land vhich is the subject of [he application as their names <br />appear upon the records in the Weld County Clerk and Recorder's Office, or <br />from an o4-nership update from a title or abstract company or an attorney. <br />• <br />The foregoing instrument vas subscribed and sworn to before me this <br />day o f ,. 19_~ <br />WITNESS my hand and official seal. <br />i!y Commission expires: <br />Notary Public <br />• .. <br /> <br />