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DOH Form No. 790 <br />STATE DEPARTMENT OF HIGHWAYS <br />DIVISION OF HIGHWAYS <br />STATE OF COLORADO <br />7v / ~~ L ~~ <br />Signatur <br />Robert G. Lucas <br />Type Name <br />Materials Source Specialist <br />(Ti*__e) <br />*•ttr <br />(Mortgagee <br />gnature <br />Type Name <br />(Address) <br />*** <br />STATE OF COLORADO <br />' <br />.. . <br />BOOK ~J3PAGE ~~ <br />PIT IDENTIFICATION <br />4Jm. J. VanValkenburg <br />)ss. <br />County of ~~1 es w ) <br />The foregoing••instrument•was acknowledged <br />before n~.~thi~t ;Y day of Son r< , <br />19~,`,?v~i..~~ r,+ • ~~ c «s and <br />Witr,~`s~s~~t~-R'ahr}-a d~or;ficial seal. <br />- ~:_~U <br />My ccsmrrj~Ssid~(~a~i,e' - - , 19 <br />nty,,~smb;itk ~n`Crpires /,larch 25 1 _ i ;%Q <br />Notary Pu lice <br />DISTRIBUTION: <br />Original - Dist. Matls. Engr. (For Recording) <br />1 - Each Owner <br />1 - District Engineer <br />1 - Design Engineer <br />2 - Dist. Const. Engr. <br />1 - Dist. Maint. Engr. (Maint. Pits) <br />1 - Each Holder of Mortgage Deed <br />eaa )1n ~Je.,..~)e~l~ <br />Notary Public <br />~.~ s 3 ! 1.c7~~r: Ca <br />b' .~ /~.i <br />Page 2 of 2 <br />OWNER(S) <br />By~ , 2~n1-~,E~~ <br />(Signature) <br />. P_.. L?. Van, ~lglkenhnr;__ <br />~ t ype ivame ) <br />By <br />(Signature) <br />(Type Name)•,. . <br />o . -•.. <br />,~ <br />STATE OF COLORADO = •~j'.~~V10 `~ ~, <br />~~ <br />County of C?~ •''~+~') V <br />The foregoing nstrument wss~acknowledged <br />before me this / 9 day of ,(pp-t,_~~~ , <br />~o..w,h and <br />and <br />Witness my hand and official seal. <br />My commission expires / - </~ ,19 ~ 7. <br />