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❑ Mark the box if information requested below is current in the records of the Secretary of State <br />OR complete Questions 2 through 7. <br />2. Principal office street address: 16105 CR 384 <br />(Streel name and number) <br />BUENA VISTA CO 81211-9657 <br />��`�'� Un���States �postal/ZipCode) <br />(Province — if applicable) (Country — if not US) <br />3. Principal office mailing address: P� BOX 892 <br />(if different from above) (Street name and number or Post Office Box information) <br />BUENA VISTA CO 81211-0892 <br />��`�'� U n�'�ec� States �Postal/Zip Code) <br />(Province — if applicable) (Country — if not US) <br />4. Registered agent name: (if an individual) H8tl�ahan Laurie <br />(Last) (First) (Middle) (Suffu) <br />OR (if a business organization) <br />5. The person identified above as registered agent has consented to being so appointed. <br />6. Registered agent street address: <br />16105 CR 384 <br />(Street name and number) <br />7. Registered agent mailing address: <br />(if different from above) <br />Disclaimer: <br />BUENA VISTA Cp 81211-9657 <br />(City) (State) (Postal/Zip Code) <br />PO BOX 892 <br />(Street name and number or Post �ce Box information) <br />BUENA VISTA CO 81211-0892 <br />(City) (State (Postal/Zip Code) <br />United States <br />(Province — if applicable) (Country — if not US) <br />This form, and any related instructions, are not intended to provide legal, business or tax advice, and are <br />offered as a public service without representation or warranty. While this form is believed to sarisfy minimum <br />legal requirements as of its revision date, compliance with applicable law, as the same may be amended from <br />rime to rime, remains the responsibility of the user of this form. Questions should be addressed to the user's <br />attorney. <br />REPORT Page 2 of2 Rev. Ol/O1/2008 <br />