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DOH Form No. 790 <br />STATE DEPARTMENT OF HIGHWAYS <br />DIVISION OF HIGHWAYS <br />STATE OF COLORADO <br />~~`~!~ f ~idG <br />~4r~~ (Signature) <br />Robert G. Lucas <br />(Type Name <br />^taterials Source Specialist <br />**a <br />(Mortga~Tee ) <br />By <br />' (Signature) <br />(Type Name) <br />(Address) <br />a*~r <br />STATE OF COLORADO ) <br />)ss. <br />County of ,~'1 e s c- ) <br />The foregoing instrument was acknowledged <br />before me th;:~s o day of ~, <br />19 PS°,:bv-~:. i~~~'<r f- C. L~a~ r and <br /> <br />and official seal. <br />OWNER(S) <br />By . <br />(Signature) <br />ldm. J. VanValkenburg <br />(Type Name) <br />By <br />(Signature) <br />(Type Name) <br />x t~ <br />STATE OF COLORADO ) <br />ss. <br />County of Jacahan ) <br />The foregoing instrument was acknowledged <br />before me this l &.t{t day of Decembeh , <br />1984 by Vim. J. VanVa2fzenbwtg ~ and <br />xxxxxxxxxxxxxxxxx and xxxxxxxxxxxxxxxxx . <br />Witness my hand and official seal. <br />My `~comgt~i~si6n1~b`xpires , 19 .__.,,,~-_.ktY'°commission <br />~'~f`fo,c '~~~,r ~ fMy'Comr:ission_ExpiresuhiarcT-Z5~19.~8 <br />..... <br />Notary Public <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. plaint. Engr. (Maint. Pits) <br />1 - Each Holder of Mortgage Deed <br />page :? of 2 <br />...- ~~~~ /~3 PAGE <br />~' PIT IDENTIFICATION <br />41m. J. VanValkenburq <br />expires Navembe~t 5 ,19 88 . <br /> ~ ~~fi~~ <br />otary Public <br />hI.J. (Vaadcvtd <br />P.U. Bax 1 <br />(Uakdett, CO 80480 <br />~~,•~ <br />~' .... ' <br />