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Application Review Notification Card
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USR13-0023
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37565 CR 69
A E RANCH LLC
43251 HWY 392
RANDOLPH CASS
44129 CR 77
VAL HART
44236 CR 77
ROSEANN OCHOA
44336 CR 77
ANNA SANDERS
34978 CR 83
STEVEN SCHULTZ
LAKEWOOD CO
2850 YOUNGFIELD ST
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CERTIFICATE OF MAILING
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Dated the 29th day of Ap
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ne Ranslem
Recording Secretary for Planning Commission
AFFIDAVIT OF INTEREST OWNERS
SURFACE ESTATE
Property Legal Description: PT SW 1/4 OF SECTION 21, TOWNSHIP 8N, RANGE 62 WEST
Parcel Number 05 45-20-3-00-017
(12 digit number - found on Tax I -D. information, obtainable at the Weld County Assessor's Office or www. co.weld co.us)
(Include all lots being included in the application area, if additional space is required, attach an additional sheet)
THE UNDERSIGNED, being first duly sworn, states that to the best of his or her knowledge the attached list is a
true and accurate list of the names, addresses, and the corresponding Parcel Identification Number assigned by
the Weld County Assessor of the owners' of property (the surface estate) within five hundred (500) feet of the
property being considered. This list was compiled from the records of the Weld County Assessor, or a person
qualified to do the task, and shall be current as of a date no more than thirty (30) days prior to the date the
application is submitted to the Department of Planning Serrv�es. �7
By: uft-Ve
Title: re5 aen! je,Mon7cc L7i'cvid Vic•
/ /
The foregoing instrument was subscribed and sworn to me this
WITNESS my hand and official seal.
lCl/►2/
My Commission Expires:
G ./ vi FiFFIP1G'c
NOTARY----
rkik OF t:pi O
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PUBLIC
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WELD COUNTY COLORADO LAND RECORDS
AFFIDAVIT OF INTERESTED LAND OWNERS
SURFACE ESTATE
THE UNDERSIGNED, States that to the best of his or her knowledge the attached list is a true and accurate list of
the names, addresses, and the corresponding Parcel Identification Number assigned by the Weld County Assessor
of the owners of the property (the surface estate) within 500 feet of the property being considered. This list was
compiled utilizing the records of the Weld County Assessor available on the Weld County Internet Mapping site,
http://www.co.weld.co.us, and has not been modified from the original. The list compiled for the records of the Weld
County Assessor was assembled within thirty days of the applications submission da e.
Account
Property Owners Within 500 ft. of Parcel # 054521300017
Parcel Owner
R3801505 054521300018 A E RANCH LLC
R6782111
R6782111
054520400002 CASS JUDY CEVILLE
054520400002 CASS RANDOLPH J
R7809399 054521000010 HART TERRY ANN
R7809399 054521000010 HART VAL G
R3801305 054521300016 OCHOA JORGE JR
R3801305 054521300016 OCHOA ROSEANN M
R3801205 054521300015 SANDERS ANNA
SCHULTZ CHRIS A
SCHULTZ STEVEN R
R3801405 I 054521300017
R3801405 054521300017
R0567186 054520000008
USA
Date
Mailing Address
37565 CR 69
BRIGGSDALE CO 80611
43251 HIGHWAY 392
BRIGGSDALE CO 80611
44129 COUNTY RD 77
BRIGGSDALE CO 80611
gnature
44236 CR 77
BRIGGSDALE CO 80614
44336 COUNTY ROAD 77
BRIGGSDALE CO 806119233
34978 COUNTY RD 83
BRIGGSDALE CO 80611
2850 YOUNGFIELD ST
LAKEWOOD CO 80215
CERTIFICATION
RE: NOTIFICATION OF MINERAL INTEREST OWNERS AND LESSEES
The undersigned Applicant certifies compliance with the provisions of C.R.S. § 24-65.5-
103(1), and in support thereof, states and certifies as follows:
1. That Applicant has provided notice, (a copy of which is attached hereto as
Exhibit "A"), containing the time and place of the initial public hearing on its application
for Case Number USR13-0023, the nature of the initial public hearing, the legal
description by section, township and range of the property which is the subject of the
initial public hearing, and the name of the applicant;
2. That said notice was provided thirty (30) days prior to the scheduled
public hearing, that it was provided by certified mail, return receipt requested, or by a
nationally recognized overnight courier;
3. That said Exhibit A includes the list of the names and addresses of the
surface owners, mineral estate owners and lessees of mineral interests to whom the notice
was sent, including those persons who have requested receipt of such notices, pursuant to
C.R.S. § 24-65.5-103(3).
APPLICANT:
STATE OF Colo y4O
COUNTY OF Dodder
Subscribed and sworn to before me this (3 day of June. 20J5, by
i5 L€ il5u tv i
Note: This Certification must be received by the Weld County Department of Planning
Services prior to or at the initial public hearing. If the Certification is not received by that
time, the hearing will be rescheduled to a later date, and Applicant must re -notify all
owners of mineral interests.
GRANT'A EFFINGER
NO C •OE OF` p_suc
NO -.atT COLORADS
' O n 20'14, + 0
SENDER: COMPLETE THIS SECTION
MMPLET': THIS SECTION ON DELIVERY
• Complete Items 'I, 2, and 3. Also complete
Item 4 if Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mallpiece,
or on the front If space permits.
1. Article Addressed to:
Calvin Mays
9966 S. Ramshead Court
Highlands Ranch, CO 80130
&
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B
roved by (Printed Nome)
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C: Date of Delivery
D. Is delivery address different from Item 1? O Yes
If YES, enter delivery address below: O No
3. Service Type
l certified Mall
❑ Registered
❑ Insured Mall
4. Restricted Delivery? (Extra Fee)
O Express Mali
O Return Receipt for Merchandise
❑ C.O.D.
O Yes
2. Article Number
(Transfer from service label)
PS Form 3811, February 2004
7013 0600 0001 6779 8762
Domestic Return Receipt
• Complete Items 1, 2, and 3. Also complete
Item 4 If Restricted Delivery Is desired.
• Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailplece,
or on the front if space permits.
1. Article Addressed to:
Peggy Elliott
12979 Larimore Circle
Omaha, NE 68164
2. Article Number
(Transfer from service labea
102595-02-M-1640
A Signature
X
B. Received by (Printed Name)
p,,.'It a El- nto,+
D. Is delivery address different from item 1? • Yea
If YES, enter delivery address below: O No
❑ Agent
❑ Addressee
C. Date of Delivery
3. Service Type
Meddled Mee
O Registered
❑ Insured Mall
4. Restricted Delivery? Para Fee)
O Express Mall
O Return Receipt for Merchandise
O C.O.D.
7013 0600 0001 6779 8748
PS Form 3811, February 2004 Domestic Return Receipt
SENDER: COMPLETE THIS SECTION
• Complete Items 1, 2, and 3. Also complete
Item 4 if Restricted Delivery Is desired.
• Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the rnailpiece,
or on the front If space permits.
1. Article Addressed to:
Carol Ann Scarpinati
3836 Tahiti Lane
Modesto, CA 95355
102596 -02 -M -154p
A. Signature
X
B. Received by (Printed Nem i
c o
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❑ Agent
❑ Addressee
o ..f Delivery
D. Is deevery address d Mom Beet14 •
If YES, enter delivery a4dieas belot4 O
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0
3. 5e Type
Certified Mall O Express Mall
❑ Registered O Return Receipt for Merchandise
O Insured Mall ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
❑ Yee
2. Article Number
(Transfer from service labia
7013 0600 0001 6779 8717
PS Form 3811, February 2004
unmesnc Return Receipt
102595-02.M-1540
• Complete items 1, 2, and 3. Also complete
item 4 If Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
or on the front If space permits.
1. Article Addressed to:
Linda French
13785 E. Marina Dr.
Unit A
Aurora, CO 80014
2. Article Number
(Measles from service !thee
PS Form 3811, February 2004
El Agent
O Addressee
B. Re eived by (Pn el C. Dile of Delivery
F)V4 / 2-13,
D. Is deliveryaddress different from Item 1? O Yes
if YES, enter delivery address below: O No
3, Service Type
2'Certlfled Mall
O Registered
0 Insured Mall
4. Restricted DelNeyf (Extra Fee) El Yes
O Express Mall
❑ Return Receipt far Merchandise
❑ C.O.D.
7013 0600 0001 67-29 8700
Domestic Return Receipt
• Complete Items 1, 2, and 3. Also complete
Item 4 If Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
or on the front if space permits.
D. Is delivery , , 'ass different from item 1? ❑ Yes
11 YES, enter delivery address below: ❑ Na
1. Article Addressed to:
Carl E. Mays
4864 Glen Isle Drive
Loveland, CO 80538
102595-02-M-1540
Agent
Addressee
C. Date of Delivery
l0—/3 /3
3. Servlce type
@'Cerllfled Mall
CI Registered
0 Insured Mail
4. Restricted Delivery! (Bata Fee)
Cl Express Mall
Cl Return Receipt for Merchandise
❑ C.O.D.
2. Article Number
(Ransfor tom service label)
PS Form 3811, February 2004
7013 0600 0001 6779 8724
Domestc Return Receipt - �moeva2.hLt 040
• Complete Items 1, 2, and 3. Also complete
Rem 4 if Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mallpiece,
or on the front rf space permits.
1. Article Addressed to:
Lynn Phillips
PO Box 293
Bellvue, CO 80512
2. Article Number
(transfer from service 1080
A. SS'ennaalPro
X iyttr_-63/a-Limo ❑ Agent
O Addressee
S. Received by (Printed Name) C. Date of Delivery
F.1, KIN frUIt1 4 r/ I
D. la delivery address different fn3m Item 1? Yes
II YES, enter delivery address below: O No
3. Service Type
Ei'Irdged Mall
O Registered
❑ Insured Malt
CI Express Mal
❑ Return Receipt for Merchandise
❑ C.O.D.
Restricted Delivery? (Eats Fee)
7013 0L30 0001 6779 8731
❑ Yea
PS Form 3811, February 2004 Domestic Return Receipt
102595-0RF}1540
SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
?:rtiontesgroup
• Complete items 1, 2, and 3. Also complete
kern 4 If Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mallpiece,
or on the front if space permits.
1. Article Addressed to:
Estate of Virginia H. French
Attn: Diann Corliss, Personal
Representative
P.O. Box 691
Kersey, CO 80644
2. Article Number
(transfer from service (ebe9
PS Form 3811. February 2004
A. Sig
X
( ❑ Agent
■ Addressee
B. Received by (P Wed Name) C.)pare of Delivery
em 1? ▪ ❑Yes
w: ❑ No
D. Is delaeryaddress different trove
if YES, Aster deliencaddresA�e
1
3. Service Type
6Carttfled Mall
❑ Registered
O insured Mall
4. Restricted Delivery? (Extra Fee)
❑ Express Mall
❑ Return Receipt for Merchandise
❑ C.O.D.
0l, 0600 0001 6779 8687
SENDER: COMPLETE THIS SECTION
■ Complete Items 1, 2, and 3. Also complete
Item 41f Restricted Delivery la desired.
• Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailplece,
or on the front if space permits.
Domestic Return Receipt
1. Article Addressed to:
Diann Corliss
P.O. Box 691
Kersey, CO 80644
0 Yes
102595-02-d-1640'
COMPLETE THIS SECTION ON DELIVERY
A. Si
UFO
0 Agent
—$-rtEe :ee
B.
e RsceNetlb (PrlrtLed Name) C. Date of Delivery
a ; rA I7 "13
O. Is doIntry addrea Parent f ttem l? ElYes
If YEp, enter del addrf{y-
s, low: 0 No
1
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3. re
Certified Mall O Express Mall
0 Registered O Return Receipt for Merchandise
❑ insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
0 Yee
2. Article Number
(Ranier from service Iabe9
PS Form 3811, February 2004
Permontes Group, Inc.
625 Main Street
Longmont, CO 80501
Office: (303) 746-3530
Fax: (888) 716 2411
permontesgroup.com
7013 0600 0001 6779 8694
Domestic Return Receipt
Prudential LTM, Realtors
ATTN: Kanemoto
275 S. Main Street, Suite 100
Longmont, CO 80501
102595-02-M-1540
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POLAR GAS FRONT RANGE, LLC
MINERAL ESTATE OWNERS LIST
Carl E. Mays
4864 Glen Isle Drive
Loveland, CO 80538
Estate of Virginia H. French
Attn: Diann Corliss, Personal
Representative
P.O. Box 691
Kersey, CO 80644
Diann Corliss
P.O. Box 691
Kersey, CO 80644
Linda French
13785 E. Marina Dr.
Unit A
Aurora, CO 80014
Carol Ann Scarpinati
3836 Tahiti Lane
Modesto, CA 95355
Mary Louise Brown
2005 Boston Way
Modesto, CA 95355
Lynn Phillips
PO Box 293
Bellvue, CO 80512
Peggy Elliott
12979 Larimore Circle
Omaha, NE 68164
Joan Russell
500 Thorington Court
Greer, SC 29651
Calvin Mays
9966 S. Ramshead Court
Highlands Ranch, CO 80130
permontes youp
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