This government document is issued by Conejos County for use in Colorado
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https://www.google.com/url?client=internal-element-cse&cx=f69629cf8ccc945c6&q=https://conejoscounty.colorado.gov/sites/conejoscounty/files/Owner%2520-%2520Representative%2520Authorization%2520Form.pdf&sa=U&ved=2ahUKEwj2n9r2v7CHAxVaS_EDHZdWBmgQFnoECAMQAQ&usg=AOvVaw19lrvbDJVvkLhfX4Wih8G7&fexp=72519171,72519168