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<br />page.l:- of 1- <br /> <br />Re,..,sed 4(20195 <br /> <br /> Mailing Address of Are yOU a registered Are yo"-'- a non- See Exhibit 'b ' attached <br /> Date of --=-- <br /> Signature of LandownerlPetitiOner elector, resident resident landowner hereto and incorporated intO this <br />LandownerlPetitiOner Signing of petit,on by th,' reference, for the <br /> Each landowner of the of the area proposed legal description of \. he land <br /> area proposed to be to be anne);.ed? <br /> Signature anne);.ed? ('i. eS or No) owned by this signer <br /> ('{es or NOl <br />~ ~5.1(,..q5 p.O. BOX 411 "No ",!eS <br /> )n~ Boulder, CO <br /> 80306-0411 <br />nomer page, <br />Chair, Board of <br />CountY corotnissionE rS <br />of the County of <br />Boulder, state of <br />colorado <br /> <br />SlGNKfURE SrU:.ET <br /> <br />"\ <br /> <br />--- <br /> <br />5 <br />