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Town of Monument 645 Beacon Lite Road Monument, CO 80132-0325 Ph: [PHONE REDACTED] ANNEXATION CHECKLIST An application for annexation shall be accompanied by the following information, unless one or more items are specifically waived in writing by the Planning Director: The Development Review Application form. The applicable annexation fee. A vicinity map indicating the location of the property. A legal description of the property. Proof of legal ownership in the form of a current title policy. A project narrative or Letter of Interest, including a statement of the purpose of the application, a brief description of the proposed annexation, and confirmation that the property is eligible for annexation in accordance with C.R.S. 31-12-101, et seq. Identify zoning if proposed concurrent with annexation. A letter of representation, signed and notarized by the property owner(s), for any applicant that is not a property owner. An annexation petition prepared in accordance with C.R.S. 31-12-101, et seq. An Affidavit of Circulator prepared in accordance with C.R.S. 31-12-101, et seq. An annexation map prepared in accordance with C.R.S. 31-12-101, et seq., including: Boundaries of each ownership parcel within the area to be annexed. Name of annexation. Date, scale and North sign. Location of proposed annexation site to Town’s existing boundaries. Boundaries of any special districts having jurisdiction over the area to be annexed. The location and width of streets and utility easements either within or adjacent to the area to be annexed. The location and site of nearest existing utility lines. Any existing development in the area to be annexed. The current source of water, sanitary sewer, and storm drainage service for the area to be annexed. Proposed zoning of the area to be annexed and exact zoning boundaries. A professional engineer or land surveyor’s statement of preparation with stamp and signature. Other signature blocks required for recordation (Refer to Signature Blocks for Annexation) A map in a GIS shapefile format compatible with the County GIS database. An annexation impact report prepared in accordance with C.R.S. 31-12-101, et seq. Note: An annexation impact report is not required for any property less than ten (10) acres in size. Any pre-annexation agreement(s) negotiated with the Town of Monument. A Special Warranty Deed for conveyance of water rights (attach Special Warranty Deed). State Engineers consent form (attach Non-Tributary Ground Water Consent Landownership Statement). Any other special reports and/or information deemed necessary by Town Staff at the pre-application meeting. Copies of the submittal materials in a format and quantity as specified by Town staff. ---PAGE BREAK--- 1 SIGNATURE BLOCKS FOR ANNEXATIONS KNOW ALL MEN BY THESE PRESENTS: THAT BEING THE OWNER OF CERTAIN LANDS IN THE TOWN OF MONUMENT, EL PASO COUNTY, COLORADO, DESCRIBED AS FOLLOWS: LEGAL DESCRIPTION (INSERT LEGAL DESCRIPTION HERE) DO HEREBY REQUEST ANNEXATION TO THE TOWN OF MONUMENT THE ABOVE DESCRIBED PROPERTY BY: _ AS SIGNED THIS DAY OF , 20 . I HEREBY CERTIFY THAT ON THE DAY OF , 20 , APPEARED BEFORE ME (name) WHO FIRST BEING SWORN DULY EXECUTED THE ABOVE DOCUMENT. NOTARY SIGNATURE MY COMMISSION EXPIRES WATER DEDICATION: THE UNDERSIGNED HEREBY DEDICATE TO THE TOWN OF MONUMENT FOR PUBLIC USE ALL WATER AND WATER RIGHTS, BOTH TRIBUTARY AND NON-TRIBUTARY, ARISING UPON, FLOWING UPON OR LYING UNDER THE PROPERTY AS DESCRIBED HEREIN. BY: AS OF SURVEYOR’S STATEMENT: I, , THE UNDERSIGNED PROFESSIONAL LAND SURVEYOR IN THE STATE OF COLORADO, DO HEREBY CERTIFY THAT THE ANNEXATION PLAT WAS PREPARED UNDER MY SUPERVISION AND THAT SAID PLAT ACCURATELY SHOWS THE DESCRIBED PARCEL OF LAND, TO THE BEST OF MY KNOWLEDGE AND BELIEF. PROFESSIONAL LAND SURVEYOR THIS SURVEY IS NULL AND VOID WITHOUT SURVEYOR’S ORIGINAL SIGNATURE AND SEAL. ---PAGE BREAK--- 2 PLANNING DEPARTMENT: THIS ANNEXATION PLAT WAS REVIEWED BY THE TOWN OF MONUMENT PLANNING DEPARTMENT THIS DAY OF , 20 . PLANNING DIRECTOR TOWN APPROVAL: PURSUANT TO AN ORDINANCE MADE AND ADOPTED BY THE TOWN OF MONUMENT, EL PASO COUNTY, COLORADO THIS DAY OF , 20 , THIS ANNEXATION PLAT IS APPROVED. MAYOR DATE ATTEST: TOWN CLERK DATE RECORDING STAMP ---PAGE BREAK--- 3 SPECIAL WARRANTY DEED KNOW ALL MEN BY THES PRESENTS, That , of the County of El Paso, and the State of Colorado whose address is , for the consideration of One Dollar and other good and valuable consideration in hand paid, hereby sell and convey to THE TOWN OF MONUMENT, Of the County of El Paso, and State of Colorado, whose address is P.O. Box 325, Monument, CO 80132, the following property situate in the County of El Paso and State of Colorado, to-wit: All water and water rights, including non-tributary and not non-tributary groundwater, appurtenant to and underlying the following described real property: (enter legal description of property and description of property and description of any existing decree for water rights). With all its appurtenances and warrant(s) the title against all persons claiming under us, and further warrant that said water rights are free and clear of all liens and encumbrances. Signed and delivered this day of , STATE OF COLORADO ) ) ss. COUNTY OF ) The foregoing instrument was acknowledged before me this day of , by . ---PAGE BREAK--- 4 Witness my hand and official seal. My Commission Expires: Notes: 1. Person signing for a corporation must be the President or a Vice President of the corporation and title must be stated with signature. 2. Notarization (acknowledgement) must also be completed. 3. Please attach any separate legal description. ---PAGE BREAK--- 5 STATE OF COLORADO OFFICE OF THE STATE ENGINEER DIVISION OF WATER RESOURCES NON-TRIBUTARY GROUND WATER CONSENT LANDOWNERSHIP STATEMENT I (We) Name whose mailing address is Street City State Zip claim and say that I (we) am (are) the owner(s) of the following described property consisting of approximately (insert legal description) acres in the County of El Paso, State of Colorado: and that I (we) have granted written consent to the Town of Monument to withdraw ground water from the * aquifer as evidenced by the attached copy of a deed or other document recorded in the County or Counties in which the land is located, and that said ground water has not been conveyed or reserved to another, nor has consent been given to withdrawal by another except as indicated in the attached deed or other recorded document. Further, I (we) claim and say that I (we) have read the statements made herein; know the contents hereof; and that the same are true to my (our) own knowledge. Signature Date Signature Date * Enter Dawson, Denver, Arapahoe or Laramie-Fox Hills – one form required for each aquifer.