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<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 punl5hable as a Class 1 <br />misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this l3~"1 day of YYlc~rcl-, Ig Z . <br />1~oFPaT CoaaT.? ROAD 17EPArLTUtF~.7r <br />Applicant/Operator <br />By: By: <br />Title: ~, , .~ .~.,,.. ~~ <br />State of Co4orn~_) <br />ss. <br />County of YYIu~~~} ) <br />If Corporation Attest (Seal) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this y~rh day of YY1„r~.h i99 z <br />by ~CLrrerl ~ ~'r~~ as ~loc.[~ ~v~~so'J of (Ylo~a~ Crv. ~ Q~,a tea;, <br />Notary Public <br />My Commission Expires: 3-12-`j,~~ <br />(08/91) 2823E <br />