HomeMy WebLinkAboutBROOKDALE SENIOR LIVING - FDP - FDP120017 - SUBMITTAL DOCUMENTS - ROUND 1 - LEGAL DOCUMENTSCity of
F6rt Collins
Community Development & Neighborhood Services
281 N College Ave. P.O. Box 580
Fort Collins, CO 80526
Phone 970-416-2740 Fax 970-224-6134
CERTIFICATION OF MINERAL ESTATE OWNER NOTIFICATION
PROJECT NAME: t-5F—r-DAL-E Se�toe— LvAiac4 �XP�as�w.l
CITY OF FORT COLLINS FILE NUMBER: 31Zo5810 B12otie"11
The undersigned does hereby certify that the developer/applicant for the above
named Application for Development in the City of Fort Collins has provided
notice as required pursuant to Section 24-65.5-103 of the Colorado Revised
Statutes to any owner or lessee of a mineral estate underneath a surface estate
that is subject to the Application for Development, or that the developer/applicant
has obtained a waiver of the right to notice from any such mineral estate owner.
❑ If a waiver has been obtained, a copy thereof must be attached to this certificate.
Indicate by checking the box if attaching a copy of the waiver signed by all
mineral estate owners.
❑ Indicate by checking the box if the undersigned certifies that the mineral estate
has not been severed from the surface estate for the above named Application
for Development.
Applicant's Signature: ���-- Date: /° /2
State of Ct"Co )
ss.
County of��
Acknowledged before me this 7 day of �� 201_/;by
/ , f /j..wat._ ) A T
Witness u tHIA and
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