STATE OF COLORADO  )
) ss.
COUNTY OF ARAPAHOE  )

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

1. That the undersigned has filed a land development application relating to the following property:

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

2. That a public hearing on the application has been scheduled before the __________________ on ___________________, 20____.

3. That attached hereto is a correct list of the names and addresses of all lot owners within one thousand (1,000) feet of such property, as required by the Greenwood Village Municipal Code.

4. That, at least fifteen (15) consecutive days prior to the date of the public hearing, I mailed to said lot owners by certified mail, return receipt requested, a copy of the application.

5. That attached hereto are receipts for the certified mailing.

_______________________________________
Applicant's Name (Printed)

_______________________________________
Applicant's Signature

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

_______________________________________
Notary Public

(SEAL)

My commission expires: ____________________.