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REV04736
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REV04736
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Entry Properties
Last modified
8/25/2016 1:02:57 AM
Creation date
11/21/2007 9:20:18 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1981057
IBM Index Class Name
Revision
Doc Name
TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS APPLICATION FORM
Type & Sequence
SO1
Media Type
D
Archive
No
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. ~ '' ~ • <br />-3- <br />PERMITTEE <br />rQ/del1llC SIP {r~a~ue - AI3~A <br />1JCr r ~7 DU rl YIN S~AYI r,~Q <br />Name of Permittee <br />By <br />Signature of Of 1 er <br />~- _ <br />Title of Permittee <br />NOTARY FOR PERMITTEE <br />State of Co V o r ndo <br />County of <br />~or`.mar' ) <br />• <br />SUCCESSOR OPERATOR <br />/nllell C SS ~~r'a ~.IUe /' <br />/-I.^ ~<I N S 1 4 r ~C S !'b h P 1. O h Fb <br />Name of Successor <br />Signature of Offic r <br />~~., r~ <br />Title of Successor Operator <br />The foregoing instrument was acknowledged before me this 13 day <br />Of ~~ 9:S by ~r~~~S 1`n S'erv~~.v <br />a5 Coo - ewn~r Of Qtr<ho. d P~~K Si-o~~ Coop.^~ <br />Notary Public Q~~,W,.,~ <br />NOTARY FOR SUCCESSOR <br />State of Colo r.l. ) <br />-) <br />County of l~or'~ T~~ _) <br />My Commission Expires <br />i~-0`I-4V <br />The foregoing instrument was acknowledged before me this ~_ day <br />of c~.,i~ q3_, by Rc1~s fn S~rg~i, <br />ds Sccr. ~r r~ ~ ~('¢., S. ttr Of RiTti~alLi+ ~ <br />1,`~~^T enK $'Eon~ corn Pon <br />Notary Public Q.oA (~ W a~ <br />My Commission Expires (a-oy-9fo <br />
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