Microsoft Word - Road Name Affidavit

ROAD NAME CHANGE AFFIDAVIT

Confirmed by the undersigned to change the road name from _________ to ________ located within the

_____________ Subdivision recorded _______, 2006 under Reception No. ______ with the County of La

Plata, State of Colorado, although it is not found when _____________ was officially created It is the

intent to make this change to be made of public record. The name of the acknowledgment of the signature

is the applicant/homeowner representative that has fully completed required procedures for county street

name change application process.

__________________________________

(NAME)

State of Colorado )

)

County of La Plata )

The foregoing instrument was acknowledged before me this

day of (DATE)

Witness my hand and official seal.

My commission expires:

_______________________________

Notary Public