SAMPLE AFFIDAVIT

I, , the of the

(Name)(Title)

hereby certify as follows:

(County, Town, or Special District)

1.That

(Name of Entity)

has established a Conservation Trust Fund pursuant to Article 21, 29-21-101, CRS 1973 as amended.

2.That

(Name of Entity)

wishes to qualify for distribution of Conservation Trust money under the provisions of CRS 29-21-201.

3.That the Governing Board of

(Name of Entity)

has duly authorized the making of this certification.

(Signature)

(Official Capacity)

Dated this day of ,

at , Colorado.