2009-09-03_REVISION - M1978143 ‎(4)‎

• Permit No: M1978143
• IBM Index Class Name: REVISION
• Doc Date: 9/3/2009
• Doc Name: Notices
• From: DRMS
• To: Various
• Type & Sequence: AR1
• Email Name: PSH
• 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 punishable as a Class 1
misdemeanor pursuant to Section 18-8-503, C.R.S.
Signed and dated this 27/ day of IP3.
Applicant/Operator If Co ration A 't t a,
By: A,
Title: Corporate Se'retary or Equivalent
Townkpf%ty/County Cleric.
State of >?? ?i (1'? -
ss.
County of )
0-
The foregoing instrument was acknowledged before me this day of ,
by as of
Notary Public
My Commission Expires:
2823F (02/05/93)