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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 ~r~day of ~iO,P/~- /~~s . <br />CUSTER COUNTY ROAD & BRIDGE <br />Applicant/Operator <br />By: RICK PERSCHBACHER Q~~Er~;w.t~-~~~"'~ By: <br />Title: ROAD SUPERVISOR <br />State of COLORADO ) <br />> ss. <br />County of CUSTER ) <br />porate Secretary~or Equivalent <br />Town/City/County Clerk <br />The foregoing Instrument was acknowledged before me this 3sd day of April <br />by Rick Perschbacher aSRoad Supervisor ~f Custer County <br />L~n ~ A ! no~ I.. d~~ol. ~ .1 ~ <br />'.' /'~ ~~~k~ Deputy County Jerk <br />• ~ y t ~, 4p <br />.,, ~ ~' ~, ~~ My Commission Expires:XX~{ <br />2823E (02/05/93) <br />r ,-- <br />i. -~\ d <br />"! ~~, ~ ,2 ra .I <br />~r .~f~ _ lJ <br />r.~ ~ ~ `Y. <br />. -- - J <br />~~> <br />If Corporation Attest (Seal) <br />~- <br />