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r ~ • . <br />AFFIDAVIT OF INTEREST OWNERS <br />SURFACE ESTATE <br />Application No <br />Subject Property ( {-~~e ~~ "~~L F-~~il V ~~ <br />STATE OF COLORADO ) <br />ss. <br />COUNTY OF WELD ) <br />THE UNDERSIGNED, being first duly sworn, states that to the best of his <br />or her knowledge the attached list is a true and accurate list of the names, <br />addresses and the corresponding Parcel Identification Number assigned by the <br />Weld County Assessor of the owners of property (the surface estate) within <br />five hundred (500) feet of the property subject to the application. This list <br />was compiled from the records of the Weld County Assessor, or an ownership <br />update from a title or abstract company or attorney, derived from such <br />records, or from the records of the Weld County Clerk and Recorder. THe list <br />compiled from the records of the Weld County Assessor sha have been <br />assembled within thirty (30) days of the applic mission dat,~ <br /> <br />The foregoing instrument was subsc~/r`ilbed and sworn to before me this <br />day of 19x75. <br />WITNESS my hand and official seal. <br />My Commission expires: ~/~y/~y ~ _ <br />~7~1/ ~/7~ _'r'. <br />Not ry Public a . _ ~_: = <br />,- .' .. <br />