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perjury notice applies to each individual who causes this document to be delivered to the secretary of <br />whether or not such individual is named in the document as one who has caused it to be delivered. <br />8. N me(s) and address(es) of the <br />in ividual(s) causing the document <br />to be delivered for filing: Harvey Larry <br />(Last) (First) (Middle) (Stir) <br />5290 DTC Pkwy., Ste. 150 <br />(street name and manber or Post Office information) <br />Englewood CO 80111 <br />(City) (State) (Postal/Zip Code) <br />United States <br />(Province — if applicable) (County— if no/ US <br />(The doctmeent need not slate the true naive and address of more than one individual. Umvever, ifyou wish to state the name and address <br />of any additional individuals causing the document to be delivered for filing, mtatk this box ❑ and include an attachment staling the <br />name and address ofsuch individuals.) <br />anner: <br />Form, and any related instructions, are not intended to provide legal, business or tax advice, and are <br />;d as a public service without representation or warranty. While this form is believed to satisfy minimum <br />requirements as of its revision date, compliance with applicable law, as the same may be amended from <br />[o time, remains the responsibility of the user of this form. Questions should be addressed to the user's <br />Page 2 of 2 Rev. 11/15/2005 <br />