2013-09-04_REVISION - M1982186 ‎(3)‎

• Permit No: M1982186
• IBM Index Class Name: REVISION
• Doc Date: 9/4/2013
• Doc Name: Conversion Application- Update
• From: Kit Carson County
• To: DRMS
• Type & Sequence: CN1
• Media Type: D
• Archive: No

NOTARY FOR STRUCTURE OWNER
ACKNOWLEGED BY:
Structure Owner �-,�` ��� �� r'J` S "J'` Name
T
Date a--/ 3 Title n t - -%`f -4
STATE OF C �ll �, )
ss.
COUNTY OF�1
2013
e foregoing was acknowledged before me this % / day of , �0, by
+C L''' am/ ' 1� as / �� of zii Lz�°
7
My Commission Expires:C'/
otary Public
PAULA S. WEEKS
2, -14027129
MY COMMi`»ION EXPIRES AUG. 20, 2016