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HomeMy WebLinkAbout20252888.tiffPlanning & Building Department COLORADO 1200 Dexter Unit W13 Phone: 720.928.4003 Fort Lupton, CO 80621 Fax: 303.857.0351 www.fortluptonco.gov October 14, 2025 RECEIVED OCT 11 2025 LG EVERIST NE WELD COUNTY ANNEXATION IMPACT REPORT COMMISSIONERS Statement of Purpose This Annexation Impact Report, which has been prepared pursuant to Section 31-12-108.5 of the Colorado Revised Statutes, is based on the Annexation Petition for an annexation known as the LG Everist NE Annexation, submitted by the Applicant, Lynn Mayer Shults with L. G. Everist, Inc. It is being reviewed and evaluated by the City of Fort Lupton staff, and is scheduled for review by the City of Fort Lupton Planning Commission on November 13th, 2025 at 6:00 PM and City Council on December 2n`', 2025 at 6:00 PM. Please contact Todd Hodges or Zachary Mettler in the Planning Department at the address on the header of this report, or at telephone number 720-928-4003, with any comments and/or questions. Project Description The property proposed for annexation is located in a portion of Section 19, Township 2 North, Range 66 West of the Sixth Principal Meridian, County of Weld, State of Colorado. The property is situated generally east along County Road 25, starting approximately 1,283 feet north of County Road 18, more or less. The total acreage of the LG Everist NE Annexation is 150.022 acres, more or less. The annexation meets the 1/6t" or 16.67% contiguity requirements set by State Statutes. The annexation map is attached along with the vicinity map. Requested zoning for the properties proposed for annexation is 'A' Agriculture and is substantially compliant with City of Fort Lupton Zoning Regulations. The land is currently zoned Agricultural in Weld County. This report is divided into six elements, which correspond to C.R.S. 31-12-108.5(1)(a) through (f) and are set forth as follows: (a) a map or maps of the municipality and adjacent territory to show the following: to I Zn 1 Z5 (I) The present and proposed boundaries of the municipality in the vicinity of the proposed annexation; (II) The present streets, major trunk water lines, sewer interceptors, and outfalls, other utility lines and ditches, and the proposed extension of such streets and utility lines in the vicinity of the proposed annexation and; (Ill) The existing and proposed land use pattern in the areas to be annexed. cjit Ls �'. Sc Cis1 Tt LD6JMN un), ?Lc) (O4 ! oh) , i µ KEI I Ce/55), fil3K CDKI CIS CS&), m.A-P5 IU�ZZ�25 2025-2888 (b) a copy of any draft of the annexation agreement, if available; (c) a statement setting forth the plans of the municipality for extending to or otherwise providing for, within the area to be annexed, municipal services performed by or on behalf of the municipality at the time of annexation; (d) a statement setting forth the method under which the municipality plans to finance the extension of the municipal services into the area to be annexed; (e) a statement identifying existing districts within the area to be annexed; (f) a statement on the effect of annexation upon local public school district systems including the estimated number of students generated and the capital construction required to educate such students. The following maps* have been attached as required in subparagraph (a) of C.R.S. Section 31-12-108.5: The present and proposed boundaries of the City of Fort Lupton in the immediate vicinity of the proposed annexation; The present streets, major water transmission mains, primary sanitary sewer outfalls, storm drainage infrastructure, ancillary utility mainlines, irrigation canals and ditches, and the proposed extension of such streets and utility services in the vicinity of the proposed annexation; The existing and proposed land use pattern in the area. The existing land use pattern is agricultural and residential. In addition, pursuant to the requirements of subparagraphs (b) through (f), inclusive of said section, the following items have been addressed or presented: (a) A final Annexation Agreement and Annexation Ordinance shall be submitted to the Weld County Clerk and Recorder for recording and to the Weld County Attorney, upon request. (b) The plans of the City of Fort Lupton for extending municipal services to, or otherwise providing for, municipal services to the subject property to be annexed as follows: 1. On -Site / Off -Street Improvements: The annexation agreement will address any future improvements. This will be specifically reviewed at time of development and will require development agreements. 2. Dry Utilities to Service Property: Electrical, telephone, cable television and natural gas facilities are located in the vicinity of the property or already serving the property to be annexed. 3. Water Transmission and Sanitary Sewer Interceptors: At the time of development that requires it, the developer of the property will be responsible for all construction of any required water and sewer lines in accordance with the City's Standards or agreements. 4. Police, Fire, and Other City Services: Police protection will be provided by the City of Fort Lupton. Fire protection will be provided by the Fort Lupton Fire Protection District. 5. Water Distribution and Sewer Collection: At the time of development that requires it, the developer of the property will be responsible for all construction of any required water and sanitary sewer systems in accordance with the City's Standards or agreements 2 with other service providers and Specifications for on -site services. This item will be addressed in the annexation agreement. 6. Storm Drainage: At the time of development that requires it, the developer of the property will be responsible for all construction of any required storm drainage in accordance with the City's Standards or agreements. 7. Public Lands / Open Space: The dedication of public lands and open space will be addressed in the annexation agreement. 8. Public Facility Extension: The City does not anticipate that there will be a need for the Applicants to extend or construct any offsite public facilities, i.e. recreation centers, etc., for the annexation and initial zoning. c in the event that property is developed further and the extension of municipal services to the annexed property is required, the development of future water, sewer, and storm water infrastructure shall be accomplished by one or more of the following Financing Methods: 1. Development Fees and Surcharges collected by the City of Fort Lupton; 2. Direct Developer Financing; 3. Metropolitan Districts; 4. Special Improvement Districts; and/or 5. Otherwise by agreement between City and the Developer as deemed appropriate. (d) Consistent with C.R.S. 31-12-108.5, the Districts and all taxing entities are identified with the current 2024 property tax mill levy attached hereto. (f) This current annexation and zoning should not have any negative impact on the Weld County RE -8 Fort Lupton School District. Any future development proposals will be sent to the School District for review and comments. The School District has received a referral request for their review and comment. *Please contact Zachary Mettler at zmettler@fortluptonco.qov or 720-928-4003 to request any of the provided maps in a larger format or in electronic format. Attachments: 1. Annexation map and vicinity map with Fort Lupton boundary 2. Comprehensive Plan Land Use Map 3. Zoning map 4. Water maps 5. Wastewater maps 6. Storm drainage study area maps 7. Storm sewer map 8. Irrigation canals and ditches map 9. Ultimate Roadway Network Map 10 2024 Tax Levies Weld County, Colorado FORT L UPTONNORTHANNEXATION NO.3 TO THE. CITY OF FORT LUPTON Situate in the Southeast Quarter of Section 19, Township 2 North, Range 66 West of the 6th P.M., County of Weld, Slate of Colorado LEGEND IIIIir I.urmv.vonnl ANVI:�.nnN Nn..l ICI.SnN'f. JnNINf, 4l.RR"III n1RAl rRUr�.5!(! ]f)NINI; Af:RI['111.I11R11. IIx. ne A(RI:.+ LS ////,,sa9neo�w, l000%////7/177)///;66676,1,.. 6,97/ (YJG"A'/YH(JA/1 /n' VICI NI'IY� Al' NRo 'im JNAKY nrvr!xxnTlvN_ No._;t. _TnB l.E 'fOTAI. 0011NUANY: l0'L88.14 I_ h'. CON'1'ICUOl15 IIOUNUARY: 1 U61..`.4 1..1'. 1/U 0Y T0TA1. IIOUNUAItY: 'L78U8.24 1_k RATIO: 1:{.208 //////// DENOTES CONTIGUOUS BOUNDARY 8 10/7/2025 2:45:28 PM ,.,n.,,:'Or:,-, Scale: 1:12,000 (1" = 1,000') Vicinity Map Data layers that appear on this map may or may not be accurate, current, or otherwise reliable. ANotes: DISCLAIMER: This product has been developed solely for internal use only by Weld County. The GIS database, applications, and data in the product is subject to constant change and the accuracy and completeness cannot be and is not guaranteed. The designation of lots or parcels or land uses in the database does not imply that the lots or parcels were legally created or that the land uses comply with applicable State or Local law. UNDER NO CIRCUMSTANCE SHALL ANY PART THE PRODUCT BE USED FOR FINAL DESIGN PURPOSES. WELD COUNTY MAKES NO WARRANTIES OR GUARANTEES, EITHER EXPRESSED OR IMPLIED AS TO THE COMPLETENESS, ACCURACY, OR CORRECTNESS OF SUCH PRODUCT, NOR ACCEPTS ANY LIABILITY, ARISING FROM ANY INCORRECT, INCOMPLETE OR MISLEADING INFORMATION CONTAINED THEREIN. 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Trap Dr"- �° . • ice , R / I. .4 ..i h#o: r :shy 4viria.,amde ant ncamY,, to Scale: 1:16019 Irrigation, Ditches, and Canals Data layers that appear on this map may or may not be accurate, current, or otherwise reliable. ANotes: 10/7/2025 3:27:13 PM DISCLAIMER. This product has been developed solely for internal use only by Weld County. The GIS database, applications, and data in the product is subject to constant change and the accuracy and completeness cannot be and is not guaranteed. The designation of lots or parcels or land uses in the database does not imply that the lots or parcels were legally created or that the land uses comply with applicable State or Local law. UNDER NO CIRCUMSTANCE SHALL ANY PART THE PRODUCT BE USED FOR FINAL DESIGN PURPOSES. WELD COUNTY MAKES NO WARRANTIES OR GUARANTEES, EITHER EXPRESSED OR IMPLIED AS TO THE COMPLETENESS, ACCURACY, OR CORRECTNESS OF SUCH PRODUCT, NOR ACCEPTS ANY LIABILITY, ARISING FROM ANY INCORRECT, INCOMPLETE OR MISLEADING INFORMATION CONTAINED THEREIN. FORT LUPTON - ULTIMATE ROADWAY NETWORK GRANT AVE TIPPLE PKWY TO FREDERICK & DACONO C1 .4 SUMMIT BLVD PTO DACONO, . 1-25 & ERIE TO FREDERICK P & FIRESTONE N 5 CR 16 fib -a a asaSI N tY u s'.m CR 22 SURE I V CR 2O CR 18 a h I -d cc U tj 52 CR 12 r a I M N cc -v wa=RE aalaI C C )CR 8 CR 6 I w a a a a..�s' a 0 h CR 14.5 0 CR 22 CR 20 .-4 Ce1 U k U CR 18.5 Ili b CR 18 I NORTHLAND DR N CC U CR16 4 w a 14TH ST j tTeaaf' INS a z 1- 1r 0 z ►m w C z 0 1 a 85 M a M 4TH Si S DENVER AVE r. N tY U r KAHIL ST 9TH ST N N r. 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LUPTON TRANSPORTA11014 PLAN .C6 NO. 15915.00 MAY 2018 SHEET 1 OF 2 ilk ENGINEERING n,....i 10 701 cm • CMa inn 76'90 m7 tot cern al a A1!) • aag11111apw•. TAX DISTRICT: 2228 AUTHORITY # 0100 0208 0301 0302 0309 0506 0700 1050 1201 AUTHORITY NAME MILL LEVY WELD COUNTY 15.956 SCHOOL DIST RE8-FORT LUPTON 18.508 NORTHERN COLORADO WATER (NCW) 1.000 CENTRAL COLORADO WATER (CCW) 1.017 CENTRAL COLORADO WATER SUBDISTRICT (CCS) 1.507 FORT LUPTON FIRE 9.446 AIMS JUNIOR COLLEGE 6.305 HIGH PLAINS LIBRARY 3.179 PLATTE VALLEY CONSERVATION 0.000 LEVY TOTAL: 56.918 COLORADO Planning & Building 130 S. McKinley Avenue Phone: 720.928.4003 Fort Lupton, CO 80621 EL, 0351 www.fortlurn n CITY OF FORT LUPTON NOTICE OF PUBLIC HEARING OCT 1 7 2015 WELD COUNTY COMMISSIONERS Notice is hereby given that the City of Fort Lupton is in receipt of an application for an Annexation with Initial Zoning, referred to as the L. G. Everist NE Annexation located east and immediately adjacent to County Road 25 and 1,313 feet north of County Road 18, more or less in Fort Lupton, Colorado pursuant to the City of Fort Lupton Municipal Code Notice Requirements. The public hearings are to be held before the Planning Commission on Thursday, November 13th, 2025 at 6:00 P.M., and before the City Council on Tuesday, December 2nd, 2025 at 6:00 P.M. or as soon as possible thereafter. The public hearings shall be held at the Fort Lupton City Hall, 130 S. McKinley Avenue in Fort Lupton, Colorado. In the event that City Hall is closed at the time of the hearings, the public hearings will be held remotely, accessible to the public by phone and Internet. Information on how to attend the hearings will be provided in the agenda as posted on the City's website, www.fortluptonco.gov. Further information is available through the City Planning and Building Department at (720) 928 4003. ADDITIONAL INFORMATION AND DOCUMENTS ON THIS APPLICATION CAN BE FOUND AT BIT.LY/FLDEVELOPMENT AND SCROLLING DOWN TO THE ROW TITLED: L. G. Everist NE Annexation ALL INTERESTED PERSONS MAY ATTEND LEGAL DESCRIPTION A parcel of land, being a part of Lots 3, 4, 5 and 6, Lupton Meadows Land Company Map of Division No. 3, Section 19, Vacation and Replat of Lots 1-8, recorded December 3, 1996 as Reception No. 2523266 of the Records of Weld County, located in the West Half (W1/2) of Section Nineteen (19), Township Two North (T.2N.), Range Sixty-six West (R.66W.) of the Sixth Principal Meridian (6th P.M.), County of Weld, State of Colorado and being more particularly described as follows: COMMENCING at the Southwest corner of said Section 19 and assuming the West line of the Southwest Quarter (SW1/4) as bearing North 00°06'14" West being a Grid Bearing of the Colorado State Plane Coordinate System, North Zone, North American Datum 1983/2011, a distance of 2611.29 feet with all other bearings contained herein relative thereto; THENCE North 00°06'14" West along the West line of said SW1/4 a distance of 1305.65 feet to the South Sixteenth corner of said Section 19; THENCE North 89°27'16" East a distance of 30.00 feet to the Southeast corner of Lupton Meadows Annexation No. 1 recorded April 14, 2017 as Reception No. 4293736 of the Record of Weld County and to the POINT OF BEGINNING; THENCE North 00°06'14" West along the West line of said Lupton Meadows Annexation No.'s 1, 2, 3, 4 and 5 a distance of 2611.54 feet to the North line of said Lot 3; The following Twelve (12) courses and distances are along the Northerly, Easterly and Southerly lines of said Lots 3, 4, 5 and 6; THENCE North 89°07'46" East a distance of 2727.95 feet; THENCE South 00°19'53" East a distance of 1245.52 feet; THENCE South 39°43'46" West a distance of 696.13 feet; THENCE South 24°01'49" West a distance of 116.91 feet; THENCE South 31°00'59" West a distance of 583.24 feet; THENCE South 28°25'42" West a distance of 155.98 feet; THENCE South 06°35'38" West a distance of 111.87 feet to the Northeast corner of Everist Annexation No. 1 recorded August 1, 2013 at Reception No. 3952540 of the Records of Weld County; The following Five (5) courses and distances are along the Northerly lines of said Everist Annexation No. 1; THENCE South 89°28'04" West a distance of 650.00 feet; THENCE North 00°31'56" West a distance of 100.00 feet; THENCE South 89°28'04" West a distance of 30.00 feet; THENCE South 00°31'56" East a distance of 100.00 feet; THENCE South 89°28'04" West a distance of 1170.00 feet to the POINT OF BEGINNING. Said described parcel of land contains 6,452,802 Square Feet or 148.136 Acres, more or less (±), and is subject to any rights -of -way or other easements of record or as now existing on said described parcel of land. FORTLUPTONNORTHANNEXA TIO YNO. 3 TO THE CITY OFFORTLIP-TON Situate in the Southeast Quarter of Section 19, Township 2 North. Range 66 Nest of the 6th P -TL. County of Nell. Stale of Colorado LEGE% t'ICLV77Y.NAP PRELtrtl`aRY,.__,.....,...,_... rOTAL B01:\'DART'. 10200.1A L.F. COA'i:4l Ol9 BOl\DART' Atltl1.5� LF. 1 PETITION FOR ANNEXATION TO: THE CITY COUNCIL OF FORT LUPTON, COLORADO We. the undersigned landowners, in accordance with Colorado lave. hereby petition the City of Fort Lupton and its City Council for annexation to the City of Fort Lupton of the unincorporated territory. the legal description of which is attached hereto as Exhibit A and incorporated herein by this reference. located in the County of Weld and the State of Colorado. and to be known as the Fort Lupton North Annexation No. 3 (aka Northeast) to the City of Fort Lupton. As part of this petition, your petitioners further state to the City Council that: 1. It is desirable and necessary that the territory described in Exhibit A be annexed to the City of Fort Lupton. 2. The requirements of Sections 31-12-104 and 31-12-105. C.R.S.. as amended. exist or have been met in that: a. Not less than one -sixth of the perimeter of the area proposed to be annexed is contiguous with the City of Fort Lupton. b. A community of interest exists between the area proposed to be annexed and the City of Fort Lupton. c. The area proposed to be annexed will be included in the amended Special Use Permit. SUP -2013R018, Fort Lupton Sand and Gravel. d. The area proposed to be annexed is integrated with or is capable of being_ integrated with the City of Fort Lupton. e. No land within the boundary of the area proposed to be annexed which is held in identical ownership. whether consisting of one tract or parcel of real estate or two or more contiguous tracts or parcels of real estate: i. Has been divided into separate parts or parcels without the written consent of the landowner or landowners thereof. unless such tracts or parcels were separated by' a dedicated street. road. or other public way ii. Comprises twenty acres or more. and, together with the buildings and improvements situated thereon, has an assessed value in excess of two hundred thousand dollars ($200,000.00) for ad valorem tax purposes for the year next preceding the annexation, has been included within the area proposed to be annexed without the written consent of the landowner or landowners. f. No annexation proceedings have been commenced for any portion of the area proposed to be annexed for the annexation of such area to another municipality. g. The annexation of the area proposed to be annexed will not result in the detachment of said area from any school district. h. The annexation of the territory proposed to be annexed will not have the effect of extending the boundary' of the City of Fort Lupton more than three miles in any direction from any point of the boundary of the City of Fort Lupton in any one year. i. The territory to he annexed is 148 acres. more or less. in total area. 1 j. Upon completion of the annexation of the property, the property will be included in the amended Special Use Permit, SUP -2013R018, Fort Lupton Sand and Gravel. The SUP plat describes the locations and uses of the mining and reclamation of the special use permit area. Being included within the SUP. the property will not be serviced by the City's utilities or water system, and the property may at all times be used in accordance with special use permit. k. In establishing the boundary of the area proposed to be annexed, if a portion of a platted street or alley is to be annexed, the entire width of the street or alley has been included within the area annexed. and reasonable access will not be denied to any landowners, owners of any easement, or the owners of any franchise adjoining any platted street or alley which is to be annexed but is not bounded on both sides by the City of Fort Lupton. 1. If required, an impact report will be prepared and filed pursuant to Section 31-12- 108.5. C.R.S.. 3. The signer(s) of this petition comprise(s) more than fifty percent (50%) of the landowners and own more than fifty percent (50%) of the property, excluding public streets and alleys and any land owned by the annexing municipality, and are, in fact, owners of one hundred percent (100%) of the property set forth in Exhibit A attached hereto and incorporated herein by reference. 4. Upon the annexation ordinance becoming effective, all lands within the area proposed to be annexed will become subject to all ordinances, resolutions, rules, and regulations of the City of Fort Lupton, except for general property taxes of the City of Fort Lupton, which shall become effective as of the January 1 next ensuing. 5. The zoning classification requested for the area proposed to be annexed is A - Aaricultural. (as shown on the annexation map attached hereto and incorporated herein. Owner has submitted a request to include the annexed property into the amended Special Use Permit, SUP -2013R018, Fort Lupton Sand and Gravel. 6. As required by the City of Fort Lupton, an annexation agreement has been or will be executed by the petitioners herein and the City relating to this annexation and the petitioners hereby expressly consent to the terms and conditions set forth in the annexation agreement. 7. At the time of annexation, the landowner will not petition for inclusion into the Northern Colorado Water Conservancy District (NCWCD). Given that municipal water is not necessary to serve the current or future development of the Property, the Owner shall not be required to petition for inclusion in the NCWCD. However, such inclusion will be required if, at some point in the future, owner seeks municipal water services at the Property. 8. The non-refundable annexation application fee of $1816.60 is tendered herewith. 2 THEREFORE, the undersigned respectfully petition(s) the City Council of the City of Fort Lupton, to annex the territory described and referred to in Exhibit A to the City of Fort Lupton in accordance with and pursuant to the statutes of the State of Colorado. 1 4/ Land L.G. Matthew S' na Owner Everist, 1 e: Noteboom, Name: Inc. VP — Mountain Division Mailing 7321 Henderson, Date 59 of -21 E 88th signing: Address - (street, Avenue, CO 80640 Suite city, state, 200 ZIP): 2 Land Owner Name: Signature: Mailing Date of Address signing: (street, city, state, ZIP): 3 Land Signature: Owner Name: Mailing Date Address of signing: (street, city, state, ZIP): 4 Land Signature: Owner Name: Mailing Address Date of signing: (street, city, state, ZIP Code): (Additional sheets may be attached if necessary.) The foregoing signature(s) was/were subscribed and sworn to before me this day of j wy , 202.C; by M 4HiMo/ /4'eb; aAI Witness my hand and official seal. My commission expires on /2 - /C - 24,2 tt,„ Notary Public • RONALD PATRICK MURRAY Notary Public State of Colorado Notary ID # 20244045719 My Commission Expires 12-16-2028 3 Exhibit A Legal Description of Property Owned by Annexor PROPERTY DESCRIPTION Fort Lupton North Annexation No. 3 (ON THE FOLLOWING PAGES) 4 PROPERTY DESCRIPTION Fort Lupton North Annexation No. 3 A parcel of land. being a part of Lots 3.4. 5 and 6, Lupton Meadows Land Company Map of Division No. 3, Section 19. Vacation and Replat of Lots 1-8. recorded December 3, 1996 as Reception No. 2523266 of the Records of Weld County. located in the West Half (W1/2) of Section Nineteen (19). Township Two North (T.2N.). Range Sixty-six West (R.66W.) of the Sixth Principal Meridian (6th P.M.). County of Weld. State of Colorado and being more particularly described as follows: COMMENCING at the Southwest corner of said Section 19 and assuming the West line of the Southwest Quarter (SW 1/4) as bearing North 00°06'14- West being a Grid Bearing of the Colorado State Plane Coordinate System, North Zone. North American Datum 1983/2011, a distance of 2611.29 feet with all other bearings contained herein relative thereto; THENCE North 00°06'14- West along the West line of said SW 1/4 a distance of 1305.65 feet to the South Sixteenth corner of said Section 19; THENCE North 89°27'16" East a distance of 30.00 feet to the Southeast corner of Lupton Meadows Annexation No. 1 recorded April 14, 2017 as Reception No. 4293736 of the Record of Weld County and to the POINT OF BEGINNING: THENCE North 00°06'14- West along the West line of said Lupton Meadows Annexation No.'s 1, 2, 3, 4 and 5 a distance of 2611.54 feet to the North line of said Lot 3: The following Twelve (12) courses and distances are along the Northerly, Easterly and Southerly lines of said Lots 3. 4, 5 and 6; THENCE North 89°07'46" East a distance of 2727.95 feet; THENCE South 00°19'53" East a distance of 1245.52 feet; THENCE South 39°43'46" West a distance of 696.13 feet: THENCE South 24°01'49" West a distance of 116.91 feet: THENCE South 31°00'59" West a distance of 583.24 feet: THENCE South 28°25'42" West a distance of 155.98 feet; THENCE South 06°35'38" West a distance of 111.87 feet to the Northeast corner of Everist Annexation No. 1 recorded August 1. 2013 at Reception No. 3952540 of the Records of Weld County: The following Five (5) courses and distances are along the Northerly lines of said Everist Annexation No. 1; THENCE South 89°28'04'. West a distance of 650.00 feet; THENCE North 00°31'56" West a distance of 100.00 feet: THENCE South 89°28'04" West a distance of 30.00 feet; THENCE South 00°31'56" East a distance of 100.00 feet; THENCE South 89°28'04" West a distance of 1170.00 feet to the POINT OF BEGINNING. Said described parcel of land contains 6,452.802 Square Feet or 148.136 Acres, more or less (±). and is subject to any rights -of -way or other easements of record or as now existing on said described parcel of land. 5 AFFIDAVIT OF CIRCULATOR STATE OF COLORADO ) )ss. COUNTY OF WELD being first duly sworn. states upon oath that he/she is the circulator of the petition to which this Affidavit is attached and knows of his/her own knowledge that the signature of each land owner appearing on said petition is the signature of the person whose name it purports it to be. (Signature of Circulator) The foregoing Affidavit was subscribed and sworn to before me this day of , 20 . by Witness my hand and official seal. My commission expires on Notary Public 6 Hello