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<br />PiLOR TO OOt~L.ERNCi ~ 1>s ~SiiG1C91DNS ON 11E.M@{SE $OE <br />~ECE1v <br />• <br />C~1AtVGE~IN.. IADOHESS{:LOGATaON- <br />..bY~f~l_. -.. .. E~ <br />_. .. <br />wet Pear, uvF,sroac r~tnac oR 13t090M oonrtr~o(. oaM J1JL Y 2 <br />1999 <br /> . <br />. <br />1. NEW OWNER ~ <br />~//~ ~//' ~' ~ <br />NAME(S) <br />!.~l <br />. <br />~ll~".r <br />~ <br />C7 <br />~ <br />~.1~ <br />ry <br />~17~ <br />~LYG <br />f w~TEa s• <br />ST~1EEw0~uuiEF S <br />co <br /> . <br />. <br />___ <br />1 <br />...._ <br />.._. <br />1..,,. <br />v.._.. <br />. <br />t <br />G <br />Metl-ng Addraas ........LS..~-~..v.. ..... ..... J~..G ./5.~.....7.,~ ............................................... io. <br /> rw <br />ar, s~ <br />.............. -~ <br />~ <br />.G~..~9.u d .......~ ...mod 537..... <br /> +q <br />/ <br />~ <br />,pp <br />Phase l/.'i.Y.. ) .......I~.~..~...~.../S~.~.. <br />2 THIS Cii/WOE 1S FOR ONE OF 71iE <br />FOLLOWING: <br /> pp <br />WELL PERMTT NUMBER...._.._..p....~lay....-.....~~~'K=S B~[/ <br /> ^ I.fVESTOCK WATER TANK NUMBER ............................................ <br /> ^ EROSION CONTROL DAM NUMBER ............................................... <br />J. WEIl LOCATION: COUNTY .....................................................:............. OWNER'S Wl3t DESIGNATION ....................................... <br /> (Add+l fcMl Isvrl (Twl <br /> . ...... 1/4 d M ...............1/4, Se(:................. Th'p,............... ^ N. a ^ S.. RM9o................. ^ E a ^ W. ............. P.M. <br /> Dntences from Section lines . ...... ... FL from ^ N. a ^ S. Une . .......... ........ ft tram ^ E a ^ W. line. <br /> Subdivision ... ....... ... ... ..... ..... ............ ....................... Lbt .:.................. Block................... Fitmg Nnlq................ <br />4. LIVESTOCK TANK OR EROSION CONTROL DAM LOCATION: COUNTY .................................................................. <br /> ........ 114. Sec .................. Twp............... ^ N. a ^ S., Range................ ^ E. «^ W. ................. P.M. <br />S. The above listed owner(s) say(s) that he (they) own the swQUre desplbed herein <br /> The existing record fs being amentled for the idbwutg reason(s): <br /> Change (n name d owner. ^ Change in rnalling address. ^ Conection d lokxtion. <br />6. I (we) have reatl the stffiemertts made hmeir>, know the ConteMS thereof, arw state that tltey are true <br /> to my (our) knowledge. <br /> (Pursuant to Section 244104 (13)(a) C.R.S., the making d lake statemeras herein constitutes peQury in <br /> tfto secontl degree and s puMShable es a tlass t misdertlearar.] <br /> Name/T'rt1a (Please type a prlrkt) <br />,~~~~~ <br />~~~,~y <br />~ SignaMe <br />`~~ <br />~ ~'% Date <br />~i x'99 <br /> ~ <br />~ <br />~ // <br />2 <br /> <br />FOR OFFICE USE ONLY <br />ACCEPTED AS A CHANGE 1N OWNPRSHIP <br />~ <br />ANp(OR MAKING AppRE55. <br />,~~r,~Yr,.y. <br />,~ <br />~ , <br />J U L 2 0 1999 <br />Svu Fnprww er ~' <br />,_ nn, on vvrT Basin MD Use _ <br />Court Case <br />t'2 seed Pepuayx3 <br />