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REV104908
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REV104908
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Entry Properties
Last modified
8/25/2016 1:16:22 AM
Creation date
11/22/2007 1:22:05 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1980246
IBM Index Class Name
Revision
Doc Date
7/1/1994
Doc Name
REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
Type & Sequence
CN1
Media Type
D
Archive
No
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<br />-5- <br /> <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 29 day of <br />L.~ <br />Applicant/Ope to <br />By: Anthony Zellitti <br />Title: Owner <br />Stdte Of ~OLOR AtOD <br />County of ~~ PLNrq <br />SS. <br />June <br />By: <br />1994 . <br />If Corporation Attest (Seal) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this aG day of S u N r- l9gy <br />by ~/i17hoN4 Zt~LMTTI as ~LJAlE12 of ~.EtciT7/ ~T <br />a~ <br />,- Not ry Pub11c <br />_ -^=~- -_ My Commission Expires: ~~ a~!/ 9 <br />.` ~~ - <br />(04/92) 2823E <br />
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