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DOH Form No. 790 <br />PIT <br />BOOK ~~ PAGE ~~ <br />IDENTIFICATION <br />STATE DEPARTMENT OF HIGHWAYS <br />DIVISION OF HIGHWAYS <br />STATE OF COOLORADO <br />(Signatu <br />Robert G. Lucas <br />Type Name <br />Materials Source Specialist <br />Title <br />~r <br />(Mortgagee <br />8y <br />' (Signature) <br />(Type Name) <br />(Address) <br />~~ <br />STATE OF COLORADO ) <br />,..... <br />County. of ~'ry~e,~~ ) <br />The fo <br />beforg <br />19~~~, <br />was acknowledged <br />of Herat , <br />> Gu cc~f , and <br />4lm. J. VanValkenburg <br />OWNER(S) <br />_ 1 O ~ ~ ~ <br />(Signature) <br />Patricia A, t?illiams <br />(Type Name <br />Ey <br />(Signature) <br />(Type Name) <br />fxw <br />STATE OF COIARADO ~ ) - <br />.ss. <br />County of ~ ~ ~~ I17~ ~ l2 . ) <br />The foregoing instrument wa~~,,,acknowledged <br />before me t/h/is ~9 day ofl~i~a : ~F ~ , <br />19~, by NFJ~f l<iFR Q-(~~~!•~An7:C ,and <br />Witness fan .ap~oofficial seal. Witness my hand and 'of~ac~S,aL~eaha-•,:o <br />My.commi5s}~ifi @&b~rds - - , 19 My commission expires ~~,IS <br />~• <br />/hy Commission`fxpir=s /dar 25':'19138, !~'r . "`~ v'~~~ `.` <br />Notary Public Notaril.,f~lic <br />DISTRIBUTION: <br />Original - Dist. Matls. Engr. (For Recording) <br />1 - Each Owner <br />1 - District Engineer <br />1 - Oesign Engineer <br />2 - Dist. Const. Engr. <br />1 - Oist. Maint. Engr. (Maint. Pits) <br />1 - Each Holder of Mortgage Deed <br />Page 2 of 2 <br />