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Form No
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<br />790 BOa~f.1~.PAGE~~ NTT IDENTIFICATION ~ ~ ~~'"•,'~ ~'
<br />TE DEPARTF!EN7 OF HIGHWAYS
<br />ISION OF HIGHWAYS
<br />TE OF. COLORADO . ~. ,~~
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<br />l^!m. J. VanValkenburg ''"' _., _..,.yj'I;;.
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<br />,OWNER(S) - ~ ;
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<br />Robert G. Lucas _. _ _ ......_ _...' ~j ~ i- .
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<br />i4aterials Source Soe i In~na'~Il4. `Plansori' ~-~ ','i;'~
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<br />(Mortgagee ... ... ,.. ~' ,' : - .. - .. .' ..
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<br />(Signature)
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<br />(Type Name)
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<br />ATE OF COLORADO ~ ~' ~ ' ~-
<br />) STATE OF COLORADO ~ ") '
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<br />County of /'
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<br />e foregoing instrument was acknowledged The foregoing dge
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<br />instrument was acknowIl
<br />fore me this day of , his
<br />before me t -
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<br />p!t„ day
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<br />mess my hand and official "'•' ""`""`'
<br />seal. ""witness m han
<br />y d and a~g cial seal:,' ,'
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<br />commission expires _ , 13 my commission esp;.ran. W ~~, ,1`3_;
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<br />'"' "'' Notary Public '
<br />STRIBUTION:
<br />iginal -Dist. Matls. Engr. (For Recording)
<br />- Each Owner
<br />- District Engineer
<br />- Design Engineer
<br />- Dist. Const. Engr.
<br />- Dist. Maint. Engr. (Maint. Pits)
<br />- Each Helder of Mortgage Deed
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