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2013-12-10_REVISION - M1992045 (7)
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2013-12-10_REVISION - M1992045 (7)
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Last modified
6/16/2021 2:25:55 PM
Creation date
2/24/2014 9:15:46 AM
Metadata
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Template:
DRMS Permit Index
Permit No
M1992045
IBM Index Class Name
REVISION
Doc Date
12/10/2013
Doc Name
Application for transfer of mineral permit and succession of operators SO03
From
James Van Ella
To
DRMS
Type & Sequence
SO3
Email Name
DMC
GRM
Media Type
D
Archive
No
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Co <br />(City) (State) (ZIP Code) <br />e following statement is adopted by marking the box) <br />The person appointed as registered agent has consented to being so appointed. <br />4. The true name and mailing address of the person forming the limited liability company are <br />Name Leffn well Laurens <br />(if an individual) 9 <br />(Last) (First) (Middle) Ark) <br />or <br />(if an entity) <br />(Caution: Do not provide both an individual and an entity name.) <br />Mailing address cto Simpson Estates, Inc. <br />30 N. LaSal�letStreet Ste 1232 Office $ °x information) <br />Chicago IL 60602 <br />} <br />(City) Unt�eAd States �IPaval code) <br />(Province — ifapplicable) (Country) <br />((f the following statement applte.; adopt the statement by marking the box and include an attachment.) <br />❑ The limited liability company has one or more additional persons forming the limited liability <br />company and the name and mailing address of each such person are stated in an attachment. <br />S. The management of the limited liability company is vested in <br />(Mark the applicable box) <br />❑✓ one or more managers. <br />or <br />❑ the members. <br />6. r1he following statement is adopted by marking the box) <br />Q There is at least one member of the limited liability company. <br />7. (U die following statement applies, adopt the statement by marking the bm and include an attachment.) <br />❑ This document contains additional information as provided by law. <br />8. (Caution: Leave blank ifthe document does not have a delayed effective date. Stating a delayed effective date has <br />significant legal consequences. Read instructions before entering a date) <br />(Ifthe following statement applies, adopt the statement by entering a date ang jfappltcabk, time using the required format) <br />The delayed effective date and, if applicable, time of this document is/are <br />(mm/dd/yyyy hour. minute awpno <br />Notice: <br />Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or <br />acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the <br />individual's act and deed, or that the individual in good faith believes the document is the act and deed of the <br />person on whose behalf the individual is causing the document to be delivered for filing, taken in conformity <br />with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic <br />statutes, and tt the individual in good faith believes the facts stated in the document are true and the <br />document co ies with tll.' e requirements of that Part, the constituent documents, and the organic statutes. <br />X <br />ARTORG_LLC Page 2 of 3 Rev. 12101/2012 <br />
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