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Dated the 7th day of June, 2013
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addressed on the attached list this 30th day of April, 2013.
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Dated the 30th day of An
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Recording Secretary for Planning Commission
Parcel Number
AFFIDAVIT OF INTEREST OWNERS
SURFACE ESTATE
Property Legal Description: 5577 -o A / 1-/ ) o 3 a /den
1vw Cs j2 E 3ac. I i sae y9 A'8?n
5M) l3al )5 ' Nor>5S E Cy -5 fo Acc-i 1.5(,
J 0 7 _ao-d-oa-r 5L_
(12 digit number - found on Tax I.D. information, obtainable at the Weld County Assessors Office, or vn'Av 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 days prior to the date the
application is submitted to the Department of Planning Services.
Signatures of all fee owners of property must sign this application. If an Authorized Agent signs, a letter of
authorization from all fee owners must be included with the application. If a corporation is the fee owner, notarized
evidence must be included indicating the signatory has the legal authority to sign for the corporation.
I (We) hereby depose and state under the penalties of perjury that all statements, proposals and/or plans
submitted with or contained within the application are true and correct to the best of my (our) knowledge.
U/, /,-
Date
Signature Date Signature Date
-5-
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 plate.
Signature
Date
Property Owners Within 500 ft. of Parcel # 120720000052
Account Parcel
R1202796 120720200091
R4467706 120719100008
R4467806 120719100009
R4467706 120719100008
R4467806 120719100009
R4752186 120717000012
R4759086 120720000051
R4759186 120720000052
R1202496 120720200092
R1202496 120720200092
R4754686 120718000011
Owner
BERTHOD CHERYL M
BORYS DANIEL F
BORYS DANIEL F
BORYS JO ANN
BORYS JO ANN
EHRLICH ROBERT E
EHRLICH ROBERT E
EHRLICH ROBERT E
HOCKER MARY ANN
HOCKER RONALD W
WINEGARD NANCY E
Mailing Address
14834 CR 3
LONGMONT CO 80504
14737 CR 3
LONGMONT CO 80504
14737 CR 3
LONGMONT CO 80504
1853 B CHEASPEAK CIRCLE
JOHNSTOWN CO 80534
1853 B CHEASPEAK CIRCLE
JOHNSTOWN CO 80534
1853 B CHEASPEAK CIRCLE
JOHNSTOWN CO 80534
14762 COUNTY ROAD 3
LONGMONT CO 80504
4057 SPY GLASS LN
LONGMONT CO 80503
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