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SL'F:FP.C: iSTl,T~ <br />L' <br />Application No. <br />Subject Propert <br />STATE OF COLOP.ADO ) <br />ss. <br />COUNTY OF WELD ) <br />TAE UNDERSIGNED, being first duly sworn, states that to the best of his <br />or her knowledge the attached list is a true and accurate list of the names, <br />addresses and the corresponding Parcel Identification Number assigned by the <br />I:eld County Assessor of the owners of property (the surface estate) within <br />five hundred (500) feet of the property subject to the application. This list <br />was compiled from the records of the Weld County Assessor, or an ownership <br />update from a title or abstract company or attorney, derived from such <br />• records, or from the records of the Weld County Clerk and Recorder. The list <br />compiled from the records of the Weld County Assessor shall have been <br />assembled within thirty (30) days of the application submission date. <br />The foregoing instrument was subscribed and sworn to before me this <br />day of 15 <br />WITNESS my hand and official seal, <br />Tfy Commission expires: <br />Notary Public <br />• <br />`~ I <br />