2013-04-09_REVISION - M1977215 ‎(4)‎

• Permit No: M1977215
• IBM Index Class Name: REVISION
• Doc Date: 4/9/2013
• Doc Name: SUBMITTAL OF COMPLETENESS ITEMS
• From: OPERATOR
• To: DRMS
• Type & Sequence: AM1
• Email Name: RCO
• Media Type: D
• Archive: No

ACKNOWLEGED BY:
Structure Owners
Date
STATE OFT 1k() )
)ss
COUNTY OF 6; I L eSp lL )
The foregoing was acknowledged before me this / - / ik 'day of
JRA-rti b p as ()Wk.
a F\ ?\t r 1r1it�
NOTARY FOR STRUCTURE OWNERS
_
Name ,a_
�J i �
m�r�N t DoorafAc (4, 4- tom,:u t ck
My Commission Expires:
Title
, 20]a, by
of