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REV100619
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REV100619
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Entry Properties
Last modified
8/25/2016 1:11:06 AM
Creation date
11/22/2007 12:37:13 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M2003092
IBM Index Class Name
Revision
Doc Date
10/12/2005
Doc Name
Reclamation Permit Application Form
From
Nick H. Gray
To
DMG
Media Type
D
Archive
No
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<br />LAND USE DEPARTMENT <br />AFFIDAVIT OF ORIGIN <br />for <br />PROPERTY OWNER LIST <br />(zone change & specialuse) <br />I, f/licJiile~ L . J2,wy hereby affirm that, to the best of my <br />knowledge, the attached list containing _~~ names and addresses is a complete list of <br />the owners of properties that are located within 1320 feet ('/. mile) of any part of the <br />boundary of the property described in Exhibit "A", attached hereto and incorporated <br />herein (attach a copy the legal description or write in space below). [further affirm that <br />the source of said list is the records of the Montrose County Assessor, or an ownership <br />update from a title company, an abstract company, or an attorney derived from such <br />records; and that said list is current within 30 days of the date of submittal of an <br />application for a land use change for the herein described property. <br />signatttre, title <br />~.¢ lS 2ct~ <br />date <br />[f the property owner list contains more than 20 names, please provide the names on <br />mailing labels, along with a copy of the complete mailing list. <br />POLuso-Zom&SL'form <br />Phone (970) 2a9.6688 <br />.-. v ,mm ern C64n <br />
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