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_PERMIT FILE - M1987079
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_PERMIT FILE - M1987079
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Entry Properties
Last modified
5/17/2024 4:57:06 PM
Creation date
11/21/2007 11:47:18 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1987079
IBM Index Class Name
Permit File
Doc Name
REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
Type & Sequence
CN1
Media Type
D
Archive
No
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1 <br /> <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 ~~ day of 9~•/ <br /> <br />1 <br />1 <br />' State of ~'A-Q.f?il~_) <br />County of ~vww~' ) <br />1 <br />The fCoregoing instrument was <br />tby -'~ <br /> <br /> <br />' 2823E (12/92) <br />1 <br />1 <br /> <br /> <br />ss. <br />`~^'c' <br />If Corporation Attest-•CSQa'F-) -~ <br />By: <br />orporate Secretary or Equivalent <br />ToNn/City/County Clerk <br />ackno ledged before me this ~ day of <br />Notary Public <br />My Commission Expires: ~ ~ ~ <br /> <br />
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