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i <br />0 40 <br />4. I understand that statements in the application are being made under penalty <br />of perjury and that false statements made herein are punishable as a Class i <br />misdemeanor pursuant to Section 18 -8 -503, C.R.S. <br />Signed and dated this Srd da of -AeR�� <br />Applicant /Operator If Corporation Attest (Seal) <br />8y: RichAP -6 Vie «^) <br />Title: <br />State of <br />ss. <br />County of f,y -C•VC� ) <br />Corporate Secretary or Equivalent <br />Town /City /County Clerk <br />The foregoing instrument was acknowledged before me this 9" d day of ALA It <br />by PJ6,w -8 F IRVC KcEA1 as �FQK5• J9vc k LW LQ,,i vP mCi'-,f of <br />(08/91) 2823F <br />Notary Public <br />My Commission Expires: ly ai I a/ S <br />