Publisher's affidavit - form

(1) Every publisher or printer who publishes such list and notice, immediately after the last publication thereof, shall transmit to the treasurer of the proper county an affidavit of such publication made by such publisher, printer, or some other person to whom the fact of publication is known, and no publisher or printer shall be paid for such publication if he fails to transmit such affidavit within fourteen days after the last publication.

(2) Such affidavit shall be substantially in the following form: I, .............., publisher (or printer) of the .............., a .............. newspaper, printed and published in the county of .................. and state of Colorado, do hereby certify that the foregoing notice and list were published in said newspaper, once in each week, for ...... successive weeks, the last of which publications was made prior to the ................ day of ................, A.D. 20...., and that copies of each number of said paper in which said notice and list were published were delivered by carriers or transmitted by mail to each of the subscribers of said paper, according to the accustomed mode of business in this office. ...................., Publisher (or Printer) of the ................... STATE OF COLORADO ) ) ss. County of ..................................................) The above certificate of publication was subscribed and sworn to before me by the above named .................., who is personally known to me to be the identical person described in the above certificate, on the .................. day of .................., A.D. 20.... . .................................

(SEAL)