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Home My WebLink About730794.tiff /171) /L 7 ZL9/ r/Qt ce r' C,461(et L UGC 7-74 AJ/. .d‘ S'6 O,/ -01 RESOLUTION DIVISION OF LAND N0. 0805-1-4-RE-44 DETERMINED TO BE EXEMPT FROM DEFINITION OF SUBDIVISION RANGE 66, TOWNSHIP 6 NORTH, SECTION 1 SOUTHEAST QUARTER: (SE4) WHEREAS, on May 5, 1972, the General Assembly of the State of Colorado, enacted Senate Bill #35 as relates to Chapter 106 of the Colorado Revised Statutes, and WHEREAS, on August 30, 1972, the Board of County Commissioners of Weld County. Colorado, adopted Subdivision Regulations for Weld County, Colorado to comply with the prescribed Senate Bill #35, and WHEREAS, the Weld County Planning Commission has recommended to the Board of County Commissioners for recording of plat number 0805-1-4-RE-44 as provided in Section 9 of the Subdivision Regulations (exemption rules and regulations) for Weld County, Colorado. Said division of land determined to be exempt from the definition of subdivision is more particularly described as follows: Part of Section 1, Township 6 North, Range 66 West of the 6th' P.M. , Weld County, Colorado being more particularly described as follows: Beginning at the Southeast Quarter (SE4) of said Section 1 and considering the East line of said Section 1 as bearing South 00°00 00" East with all other bearings contained herein relative thereto; Thence North 89°4d 20" West, along the South line of said Section 1, 4200.40 feet; Thence North 00°12'17" West, 910.04 feet; Thence North 11°51'31" West, 246.50 feet; Thence North 81°04'00" East, 294.70 feet; Thence North 55°45'13" East, 2311.39 feet; Thence North O1°13'54" West, 178.60 feet; Thence South 88°33'22" East, 2056.98 feet; Thence South 00°00'00" East along the East line of said Section 1, 2648.54 feet to the True Point of Beginning. Said described parcel of land contains 213.713 acres, more or less. and is subject to any rights-of-way or other easements as recorded by instruments of record or as now existing on said parcel of land. NOW, THEREFORE, BE IT RESOLVED, by the Board of County Commissioners of Weld County, Colorado, that the Chairman be and heis hereby authorized to sign the plat of a division of land determined to be exempt from the definition of Subdivision No. 0805-1-4-RE-44, for recording The above and foregoing resolution was, on motion duly made and seconded, adopted by the following vote: AYES: ,!,Z.eZ/i" f , //4rr--, / )16 (Li / I C{ t, 1; THE ARD COU TY COMMISSIONERS WELD ODUN , COLORADO DATED: April 18, 1973 730794 t Rrearded aN r _o'clock �-J `�: . M----.- ....�. .�1 7 c- --.�..r ' LASSJ'�9 .. - _ 0.ec. M1a........� S�,,,-,_.�,.,�_ ..e....-.Ann Spo.r,er, Records.' / O `.2 r `vie".C2Z EM/�., AV Ail 0805-1-4— RE-44 - I $68'9w'-2y•� � . 9B' i ) 4.4eO414, � a /7414O y f .--t NA9'm'oo'w/ , `-i 3►4� LOTS• 06 .--t Ip -: s� .Sao2naoe kill 1 S 1' 23aoo is .d t �5y•A S7ts'ao'm"E o .room tI k 04 �r LDT"A' Zia k, its�-,v LOT A j Z0�.099 244,...50, LOT 24 = o.9 is Z 5 i ROAD-Rovis 4.696 3 IA 4 - TOTAL =21.3.713 'Aeries 13 !I. :* it lc 4. j'Nudi le'd W. cane County Rood"'r1 —1i/QU O"YV StZQ0.40 ,3.• --..- 1 i ZOtrfd: • nd Piro di • sQf pin r6', e `p 1 + V. i-q �—�— \ fle St U rObr�_ =---;� ;ill :Ju . 11i • ,_..„2,. . i a.5.4 h ii • Is IIt �Al. .. II i ..------ , v''' afcN � . ,crn/o:1"'2000 �, -1- 4r • 1 .; v ¢ .- -. ,1;74:+4 ,�yt- ;..4.`r. ri':5 ,+n .:e.3-x4'G" —vl'imen.+fin ..,, Country i?1✓'r 91J S l y1 , y ,/_ _ _ o : • rya 620 2623549 RECOF'DED EXEMPT!®N �►9m —02 _ O8O5-I-4-RE-44 f -t r., a ze °r ', � , '.e . . - . ...., Weld _ _ ul, de Lie? 4 ._ C _a _ J. lJ ..".. 2Pr " .. _ L _. _ .. .:.e_ L.,a_ ._.. _,e_n relative thc)r_:Cc; .. ...., a'_Or,c e out ne o n... 21\ .':0 o l , Il7u IY st, 91C.6". _ 71.'1'31" -f last, 294.70 feet; Shen :e iorth _ f r -.� r.n_\ a "1 -� • __ , .. .n oe o„.._;. v� p. .. 212. 'S. )-) Thence _, a ;. __•• i1JP. � • � , _f.C@ South R :-O .;ii f along ..'.4' w..� _!T.e^O_ ' , Jti:,• feed_ to the True Point of reginzlinz. J ri UEt parc.el of land Contains 2: 9.7' 3 acres, :dare , , a nd Is o any r u-j - . _,..ght_.,ro: .ray or other eas.^e„ts as e_,rd,... - _.__ s e rd,:oro. or as now oxisting on said idarcel of land, h ozob'f certify thad this plat. has prepared and .'^J +- 5 on. rft.,t- d .:a_ t the tame is ,correct to the best OZ .j knowledge `i �i. ze vim_ _.t .Ma u01O1tdo _ ,Q �,v. No. ii 392 1 •�, tJ� L:.ia M1.• 3r0 ❑, being zcle car:_2 . er: of `h2 ol'e 7Y _q 4=4' described descri bed JroDer V do hereby oundivide .2:he c.2.17..e =_ aC%..7 on the atta_.^.e->map• q •r rF - _ `c�'v �. . Y /7 a •; \\r` i \` A _ rt__ _cation was a.zicnowled,fed. before is 5th �nril ,A..,. 19 73 _. r • .n:s_ :y Ean.. _;.d Sea :he accor.panying plat is ac:. aped an3 approved for 1fI t r T 3..A`2i 0:-%w- . • Sated /0R- 73 - -- - - - F '•.. STATE OF COLORADO T a � COUNTY OF KELD 1 C'if IVY THAT Tins INSTRUMENI 1Y.1S to:u I,dt RECORD IN hIY OFFICE AM ! ..3.3r "of. i AND IS 1NG1.1 N. CONDI.1) IN BOOK NO/L. f PACE y 1 •'/E 14 X39 L ! an«i i� U RECORDER -. RECORDED EXEMPT/ON N' LEGAL DESCRIPTION 0805-I-4-RE-44 tart or Section 1, Township 6 North, Range 66 West of the 6th P.N., Weld County, Colorado being more particularly described as follows; eginning at the Southeast Quarter (SE,i-,) of said Section 1 and considering the East line of said Section 1 as bearing South 00°00'00" East with all other bear- ings contained herein relative thereto; Thence North 89°40'20" West, along the South line of said Section 1, 4200.40 _met; Thence North 00°12'17" West, 910.04 feet; Thence North 11°51'31" ties', 6.50 feet; Thence North 81°04'00" East, 29¢.70 feet; Then.:e North 55°jY'5'13" Last, 2311.39 feet; Thence North O1°13'54" West, 173.50 feet; Thence South 88c 33'22" ast, 20' 6.93 feet; Thence South 00°00'00" cast, along the East line of said Section 1, 2643.54 feet to the True Point of Beginning. Sai3 described parcel of land contains 213.713 acres, more or less, and is subject to any rights-o£-way or other easements as recorded by instruments of record or as now existing on said parcel of land. I hereby certify that this plat was prepared under my supervision; ..,,+o0 Fic?�4,•• and that the same is correct to the best of h knowledge and belief `i2 Fb•. Y g �K •is.a&1Le :SF '� •� f t a, •0 w JASPER , Er E ,.olorado P.E. & L.S. No. 4 : •a o, 392 v*=� 4392 lit! •o n. I Lois M. Bre, , being the sole owner in fee of the above q1 ' +;� Pr;= described property, do hereby subdivide the same as shown on the "• e•;41•11.51,1€•-.b.;•4.3.7 attached-map. /' •1:0,-; inu�+'`,,,' • The foregoing certification was acknowledged before me this 5th day of April ,A.D. 19 73 7. Notary Publis Y • Witness my Hand and Seal - � The accoapanying plat is accepted and approved for filing. HAI Y.AJ Cr THE BOARD 0F —1UNTY NISSIONERS AT:EST: County, Clerk .arB y( uC L' J Dated P- 7- Sheet 2 of 2 Joh NR 1973-160 RECORDED c xemPT/ON nAP 0805-1-4- RE-44 4 ° S ea-33'22•L ea Sc. 98' Nai �8's'w �� /78.Go m N90°a000'w 1° 4 23�+,3 Lore- [(aae T, c?� scroo 2vc'e �� ; gay I, 2saoo �ry 0 nt N�°u.za'E LOT ;4 ' 3 x ti 2942o/ � 8 A 1 I + "'24 "' LOT A =208.099 v °g S.50LOT B * 0.918 t 5 { ROAD'Raviz 4.696 3 a TOTAL =213.713 'Acres a y h .9Cre..7° II tHareh XO.W. Zing Coati& Rosati"172 ' .-.._' 1i/89.4o2o rY" cO.4o' �o - � �i- Legend: a you id Pin . Jet pin =<') •_.,_Isl e t ��II- x I= — ; I \ ",�--I_ I r J .Y� � J •• Isa • . uA CO _7:td5 CO I• 4 t e ee 1 I _ 1 T. eoAl. Pt ikinii.[/ i .Y.64 Heel >. . c9.�2Fell / e . , , i scaltins2000' 4 v • County Ro.. $7Z: t -DIVE: Q wmte: Gas H Snow'? -ri.A2 Boxe..5 �Sh `1 oft Eafcn,Calarddo Jab/ ' /n'3-1" _— p, 1 » ,' w .. k d e �-_ IA - # _ 5 1 � i y � b r d„ " " Qil � , 'y r} �i .. '4 4 I -` n ,,' a a3'r •&" S• c I �_ o Zu i 8.}i 9� Jt - �.- �- n xjt •): • �yt Y . 1 K Id i n^ r ' f '''-; ,+„21, n� #*i a r. r. 4'-•4'-• ,' � \ 4 1s�, � tom P _ kr' 'X. .... n sr• m �� 14. yy` d 1N 1ii 1 F` y a ,,. 0. _ "a' 181 e x 'v-s;. ,� s--, f e F.ad4 ; n ° z �'''~�' taw 'It�► -•lyl, + - I, bi '� i n 5+':. lit �� ., ,a.-400,! � i., d .F y�r t s v ,., ' , n, , 4 i dd - r M s R,: 1 n ' J. Y i -• -- 4 W r 1 slSp " 9' '� b i+Mef e 3Y"4 r ! yak ! At Y 9 ... sr r�' v q ` 1 y� gip' At " P / � {.A1. -sYN' i YS+M 'Gr.+ • t _ m�4 ).� • :'V �'F _ LiS�` to „� w I 4 le. t ad,-v i . +., I t Fs'd�lF'- �l r 1h ] • ' 1,, pp p ' i 1 <" i & • {tl}J:t Y Y. to el ��' ` ' lit "� t d 4,":,&", %.4 i� �� i 4.9413 `4. m . , .fix vitalitli i.=` „t 4' } ,c I { C u , w ` ,g r xk,-Yµ M., y ( ;r" y .� _ w • `� ;M �- ' I a " ,r. �j ? 1 ` r r ,,I, 11 G txi t lie v xa.—+ ' gqqpYpYyY ' a` `e— k, .� rr` 6 _ l 44 �..ilt} -tl� 1 ' 4,1 �✓ _ Q(, Y y No 9 ' �. �} as i y t •'�„ t{? 3 { o '➢ y„ a' PY� dL t As' _ i4 R ss ..t'� er w APPLICATION FOR RECORDED EXEMPTION Weld County Planning Commission-353-2212 , Services Building , Greeley , Colo . FOR PLANNING DEPT. USE ONLY : LAND CODE : CASE NO :009d57- 9-ze5 .1 T: Qr03- S • / 1 /4 : 9- DATE : 4-9-� LEGAL DESC . APPR : ) 3 APPL . FEE : SU APP . CHECKED BY : e� � Z RECORDING FEE :''e2,9 DATE SENT TO BOARD: etir>...rreefrarign„,4 G 93 RECEIPT NO . : DATED FILED & RECORDED : TO BE COMPLETED BY APPLICANT : ( Print or type only except for required signatures ) : I (we ) , the undersigned hereby request that the following described prop- erty be designated a recorded exemption by the Weld County Board of County Commissioners : LEGAL DESCRIPTION : 2o.c.:, n . ¢• G 96 ACREAGE : LOT "A" 070",pyJ ; LOT "B" Q 9/er ;TOTAL : ...2/3. 7/3 HAS THIS PROPERTY •BEEN DIVIDED FROM OR HAD DIVIDED FROM IT ANY OTHER PROP- ERTY SINCE MAY 5 , 1972? YES NO z FEE OWNERS OF PROPERTY : NAME : .loss AV. 2.ry2w.t/ ADDRESS Sire BOX S PHONE : NAME : ADDRESS457i�,,(3,40e4y, PHONE : NAME : ADDRESS PHONE : WATER SOURCE TYPE OF SEWER PROPOSED USE I hereby depose and state under the penalities of perjury that all statements proposals , and/or plans submitted with or contained within this application are true and correct to the best of my knowledge . COUNTY OF WELD ) STATE OF COLORADO Cc SSG Signature : wne�ut�otz �Agent Subscribed and sworn to before me this 20th day of March , 1973 SEAL NOTARY PUBLIC �� August 31, 1975 My commission expires : RECORDED EXEMPTION CHECKLIST (To be returned with application and completed by Planning Com- mission staff. ) The Planning Commission staff has reviewed the application for Recorded/ Exemption No . fl,4,--/- ¢-,Crf¢ submitted by ah-Es it and finds the/following : 77 I . That the proposed lots are not part of a recorded exemption from the definition of "subdivision or subdivided land" or a subdivision approved within less than five years previous ; 2 . That the proposed land division would not constitute the sub- division of a larger tract or parcel of land into more than two (2) building sites , tracts , or lots within five (5) years ; /97 �- 3 . That the lots resulting from the proposed land division will each be accessible from an existing public road with a mini - mum frontage in conformance with the County Zoning Resolution ; OA! 4 . That the proposed lots will have access to an adequate water supply; - 5 . That the proposed lots will have access to an adequate means for disposal of sewage ; 4e /re 6 . That the minimum lot size shall not be less than the zoning requirements ; G 7 . That the land division proposal is in compliance with the Comprehensive Plan ; j� � 8 . That said land division does not interfere with or lie within major floodways or drainage courses ; (d7 A‘Ar? This application / does not comply with the requirements eQd of Section 9 , Weld County Subdivision Regulations for Recorded Exemptions . urman Lorenson Date Planning Director • , WELD COUNTY PLANNING CERTIFICATE OF CONVEYANCES COMMISSION STATE OF COLORADO) COUNTY OF Wc..LD ) The TRANSAMERICA TITLE INSURANCE or ABSTRACT COMPANY hereby certifies that it has made a careful search of . its records , 'and finds the following conveyances affecting the real estate described herein since May 5 , 1972 : LEGAL DESCRIPTION : y. to _ Pr. Sb .- 1 ., yr' - � roi_ - . . _ - , _ . t . n 1 , ^ r^ • CONVEYANCES (if none appear, so state) : NONE Reception no. , Book Reception no . , Book Reception no. , Book Reception no. , Book Reception no. , Book Reception no: , Book • Reception no . , Book This Certificate is made for the use and benefit. of the Planning Commission of Weld County, Colorado . This Certificate is not to be construed as an Abstract of Title nor an opinion of Title , nor a guarantee Title , and the liability of TRANSAMERICA TITLE INSURANCE COMPANY is hereby limited to the amount of the fee paid for this Certificate. In '!fitness Whereof, TRANSAMERICA TITLE INSURANCE COMPANY has caused this certificate to be signed by its proper officer this 2nd day of Anril , A. D. 1922, at 7 .45 A.M. o ' clock. TRANSAMERICA TITLE, INSURANCE COMPANY COMPANY/) By H IZEP -SI NATURE - - -,..11.11- - ----- - . . . .. ... ~a1; 1 11 reese Cetwineering ENGINEERING CONSULTANTS MAILING AhDFESS: BOX 913 .0SPER "JAY" FREESE OFFICE, 815 16TH AVENUE REGISTERED PROFESSIONAL ENGINEER GT2EELEY, CO LO. 80031 REG:STERLEO LAND SL'RVE.YOR PHONE 352-0100 A' ?� r r ( LE3AL 1�E.'?tJ6ZIP AOI1 A tract of land locate:1 in the Southeast :•uat..0 (SEi) of Suot'_ea 1, J.)IT,TIship 6 North, fange 66 Uest. of 61.11 1".r'I., Weld {:('ivaty! Ccaoca.d,), • ;feint; more particularly described as toll.own; Bej inning at the East Quarter Corner (11 ;:lcr) of aaid ;3ection 1 and 2a.lsidering the East line of the Southeast qua:fter as bearing Scalth • n 00 00'00" East and with all other bearings contained herein relative • thereto; Thence South 00 00'00" East, ;281. 3 feet.; Thence north 90 00'00" • West, 30,00 feet to the True Point of: Begi nin€° Thence Korth 90 00'00" West, 160.00 feet; • Thenre• South 00 00'00" East, 2j0.00 feet; • • Thence South 90°00'00" East, 160.00 feet: Thence North 06'00'00" West, 270.00 fee: to the True Point of Beginning. • Said described ',excel contains 0.918 acwes, more or less, and is subject • to. any rights-of-way or other.easements as recorded. by instruments of • • rncoid or as. now existing on :;aid parcel- o • • • ,SURVEYOR'S CERTIFICATE I do hereby certify that-1 have prepared. this legal description. • • • Earch 19, 1973 JASPE: 'REE iE 0011,41 Otto .07'1 ,R FR 4g0.• +:�:lo r o .E. ?_ L.S. No, 392 V f~ • p11 '4 fL. T. 0.0 • w M� .1.• per: '^' . • • Rt . 2 , Box 8 Eaton , Colorado March 21 , 1973 Mr . Glenn Billings , Chairman Board of County Commissioners Court House Greeley , Colorado Dear Mr. Billings : I would like to request an exemption to the Weld County Subdivision Regulations for a one acre parcel of ground in the SE4 Section 1 , T 6N , R66W. The parcel is located in a 400 acres owned by Lois M. Brown . I have been farm- ing this 400 acres for the past 32 years . I have been residing in a tenant house for all these past 32 years and find that to remodel it would be more ex- pensive than to build a new one and I have requested the sale of a one acre parcel from Mr. Brown to place a new house on . The old house would be used for seasonal farm labor and I have an agreement with Mrs . Brown to continue to farm the 400 acres indefinitely. Therefore I request the granting of this exemption . F'GiS44 E . R . Gustafso moms i --- — - WELD COUNTY HEALTH DEPARTMENT 1555 17th Ave. Greeley, Colorado No. .2 3 a Application for Permit install, Construct, Alter or Repair Individual Sewage Disposal System. Owner or on r Ad ess Phone Address of Site - o 74 Co, A 46 - Mailing Address — General formation a Septic Tank 1. Living Units 1. Liquid Capacity Gallons 2. No. of Bedrooms •-Z. 2. Dimensions W L D 3. No. of Baths 3. Material 4. Basement Drain —t 4. Type Inlet 5. Automatic Dishwasher Type Outlet 6. Garbage Disposal 7. Automatic Laun Secondary Treatment 8. Size of Lot 9. Type of Soil Field Bed 10. Percolation Test 11. Water Supply 1. No.of distribution lines 12. Lot Grade 2. Trench: Width Length 13. Water Table Depth 3. Type Filler Material 14. Other 4. Depth of Filler Material 5. Gravel Size 6. Type Tile 7. Depth of Cover 8. Other The Permit is to remain in full force and effect for six (6) months from date, until revoked for non-compliance. This system will be constructed in accordance with the above specifications and regulations governing non- municipal sewage disposal systems, in accordance with Regulation No. 1 of the Weld County Health De- partment. Date: C.- /� / Applicant: \< / The plans and specifications as shown are approved, pending payment of permit fee. Sanitarian: Date: The above system inspected and found to comply with the plan and description. Installed by Date: Sanitarian: _ o O PERMIT FEE $ Received by --t- re° Date r9 • Please use reverse si a for Plot Plan or use separate sheet of paper. --- - - - ---• ., _ . — — BOARD OF DIRECTORS `.. jr'� ERNE[T TIOOE/. PRESIDENT ytr NORTH WELD COUNTY WATER D1S"I'It1G'f TOM . WI 1ST VICE PRES. ail M• D RU N ER .ND VICE PRES. _2`i Tp L HIGHWAY 85 LUCERNE. COLORADO 80648 FRED BRUNNER JR..TREASURER it iii IBI'=� . . O. A. MooRe. MGR.ADAM RUFF. SECRETARY _ o. ! _T _-- - P.O. SOX De - ANON! J66-3O3O .„- . e. / f/` `_ \ C TO WHOM IT MAY CONCERN: It is the intet of the NO TH WELD COU[�TY WATER DIS�CT to deliver water to ,-c t - r�L�fu1z� I Sincerely yours, THE NORTH WELD COUNTY WATER DISTRICT 61 . A. n 0. A. Moore, Maager OAM:wb - ,. - a.*r —_: - Weld BOARD OF HEALTH e County Health .department RALPH AA B. GREELEY 1555 I/TH AVENUE ANDREW CURTNER. GREELEY NILES S. MILLER. TTTTTEVILLE GREELEY. COLORADO 80631 ANTHONY LE HBhCM, GREELEY CLARENCE SIMIAN. GREELEY March 19, 1973 TO WHOM IT MAY CONCERN: The percolation test for Minor Subdivision has been approved by the Weld County Health Department. Owner: E. R. Gustafson Address: Rt.2, Box 8 Eaton, Colorado Location: SE'/4 Sec.1,T.6,R.66 - teae Glen E. Paul, Acting Director Weld County Health Department --- --_--Ns NI N U 1 NI I - - , } i ( V I S - I - I `N, - 1 ! 9°. � I 0 1 N\ I i � ! �` U\ I `\ -______,_ a _ < I -- c.� I ; I I a I I _ -_--_4 I \N r of 5 ..,.,.,.. ....a.---- - ___ _ _____ _ 96-4 — — — e/sr/ 7„--cc - - - ' / 77s/ - � n - - _ ---- -- - ---------- ------------------- ---- f - --- -- - -- -- -- .07// /77-5- a - 39 Z 595j - -- ----- - - - - - - - -- - -- � i /775� - - --- --- - /i,AwPor. 43,2,6;,-- - ay c----ca o - - - - ---- DDS - - - t, l77S�- qc.A8C atd is SUBDIVISION SUMMARY FORM Weld County Type of Submission: Request for Exemption >c Date : 4- 73 Preliminary Plan nt,,e, ED EXEnkonc.4.) Final Plat Subdivision Name : _[jf�/J� —/- ¢_dee'-44__ Filing Location of Subdivision : TOWNSHIP ‘ 4/1 _RANGE 4..,44..,4U� SEC / 1/4 .561SW Owner(s) NAME ZO/J /i//. /4,P0LdiU ADDRESS R7- itZ Roy '5r" ±797274) &to. Subdivider(s ) NAME „SAm0 fps IflgO1/2E_ ADDRESS Type of Subdivision Number of Area` % of ` Dwelling Units (Acres) Total Area ( )() Single Family o?L�7/2 l67) Ga ( ) Arartments ( ) Condominiums ( ) Mobile Homes _ ( ) Commercial N. A. ( ) Industrial N. A. ( ) Other (specify) Street Walkways Dedicated School Sites Reserved School Sites Dedicated Park Sites Reserved Park Sites Private Open Areas Easements Other (specify) Total • By Map Measure x/3.7/3 /QQ 2 Page 1 of 2 Estimated Water Requirements — gallons/day. Proposed Water Source(s) /y/ /�/pOM. Gf/�: J�/i m. p Estimated Sewage Disposal Requirement (� — gallons/day. Proposed Means of Sewage Disposal 47�;Sepp? . ACTION: Planning Commission Recommendation Approval ( x Disapproval ( ) Remarks Date 17, 73--_ _— 19 Board of County Commissioners Approval ( X ) Disapproval ( ) Exemption under C.R.S. 106-2-33(3) (d) (// X) Remarks ( If exemption, state reason) (_O/t��atT Cv/� Date 1-4 —93 , 1973 . t-Ans noReeer. Note : This form is required by C.R.S. 106-3-37 (4) but is not a part of the regulations of Weld —` County. Page Page 2 of 2 Hello