PERMFILE135902

• Permit No: M1994097
• IBM Index Class Name: Permit File
• Doc Date: 9/12/1994
• Doc Name: NOTICE OF FILING APPLICATION FOR MLR PERMIT FOR REGULAR 112 OPERATION NOTICE TO THE BOARD OF CNTY CO
• Media Type: D
• Archive: No

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4. I.understand that statements in the application are being made under penalty
of perjury and that false statements made herein are punishahle as a Class 1
misdemeanor pursuant to Section 18-8-503, C.R.S.
Signed and dated this ^~ day of ~ ~ ~ 7
Applicant/Operator~~ If Corporation Attest (Seal)
.r _ i
By~ ~_ _ ~V By:
Title: `~--. _ _ Corporate Secretary or Equivalent
Town/City/County Clerk
State of
County of
ss.
The foregoing instrument was acknowledged before me this _ day of
by as of
Notary Public
My Commission Expires:
(04/92) 2823E