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BOOK ~ PAGE <br />DOH Form No. 790 <br />PIT IDENTIFICATION <br />ldm. J. VanValkenbur <br />STATE DEPARTMENT OF HIGHWA'~S <br />DIVISION OF HIGHWAYS <br />STATE OF COLORADO <br />~~~~~ <br />(Signature) <br />Robert G. Lucas <br />(Type Name <br />Materials Source Specialist <br />~Tir1eJ -. <br />~~ <br />OWNER(S) <br />(S~gnature) <br />sd~;ard R. Van Valkenl~ur~ <br />(Type Name) <br />(Mortgagee) <br />(Signature) <br />By <br />(Signature) <br />{Tyne Name) <br />(Address) <br />~-rk <br />STATE OF COLORADO ) <br />)ss. <br />County of hle.s ~- ) <br />The foregoing instrument was acknowledged <br />before me this ;v day of ~i v rr , <br />19~, by- `(z~~~,-~ r; L~caS ,and - <br />,~,,,~: ,...,..and <br />Witness my,~~nd.a~i8~bfficial seal. <br />My comrviarai~i~-.~c~.~ ~'e~ ~° - _ _ 19_ <br />1 ~ . __... _ -__.._ ___.. _ . . <br />~r`~ ~~ <br />~' , titF` Notary Public <br />V ~. <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. Ftaint. Engr. (Maint. Pits) <br />1 - Each Holder of Mortgage Deed <br />(Type Name) <br />:« <br />STATE OF COLORADO ) <br />ss. <br />County of~,.lj/~,~~ ) ' <br />The foregoing instrument was acknowledged <br />before me is ~''~ ay f ~ ~ , <br />19~s byQ~~~G~~3~Ebll - ~ and <br />_.._~.--- -------- and - --- <br />Witness my hand and off' ial seal. ~ ~ <br />My commission expires ,. ~ / ,19 ,'S 4-: <br />fit' - ,~ <br />_ 1~, ~~~~ <br />~' 1 v `1 <br />~... . <br />~.~,:. <br />Done. 7 .~.F 7 <br />