STATE OF COLORADO  )
) ss.
COUNTY OF ARAPAHOE  )

The undersigned, being first duly sworn, deposes and says:

1. That attached hereto is a photograph of a sign which was posted on the following described property which is the subject of the application:

Address:_________________________________________
Legal Description: Lot _____ Block ________
Subdivision: _____________________

2. That said sign was posted at the following location(s) on the subject property: _______________ ___________________________________________.

3. That said sign was posted and was legible from the adjacent public street(s) for a period of at least fifteen (15) consecutive days prior to the date of the hearing specified on said sign.

4. That the undersigned agrees to remove said sign no more than three (3) days following the hearing specified on said sign.

_______________________________________
Applicant's Name (Printed)

_______________________________________
Applicant's Signature

Subscribed and sworn to before me this _______ day of ______________________, 20_____, by _____________________________________________.

_______________________________________
Notary Public

(SEAL)

My commission expires: ____________________.