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, a • • <br />-5- <br />4. I.understand that statements in the application are being made under penalty <br />of perjury and that false statements made herein are punishable as' a Class 1 <br />misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this 1st <br />San Miguel County <br />ddy Of July 1992 <br />Applicant/Operator <br />, <br />Title: Road Superintendent <br />State of > <br />ss. <br />County of ) <br />If Corporation Attest (Seal) <br />By: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing in trument was a~:knowledged before me this ~ day of <br />by ~ _ ~ L O~ d:~ ~~ aI~ ~~- ~f~ <br />Notary Public <br />My Commission Expires <br />(04/92) 2823E <br />