PERMFILE104809

• Permit No: C1980000
• IBM Index Class Name: Permit File
• Doc Date: 6/2/1986
• Doc Name: SMALL OPERATOR APPLICATION FOR ASSISTANCE
• From: SPANISH PEAKS CONSTRUCTION CO
• To: MLRD
• Section_Exhibit Name: Forbes Mine
• Media Type: D
• Archive: No

-5-
AFFIDAVIT
Applicant, or duly authorized representative, being first duly sworn, states
to cne best of Applicant's knowledge ano oelief, that the information
furnished is correct and complete.
A~p~icant
STHTE OF )
ss.
COUNTY uF r,~/Gjtli{~{,~-~~ )
Suoscrioed and sworn uefore
oy
of
My Co~n~nission expires:
(Rev. 8143)

c n i s ?C~~aY o f Vim- ~--~ _ O (G ,
~-~ as '~-lli-r12,(--
N ~ RY PUBLIC ~,
Uoc. No. 515a