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t <br />Co <br />(City) (State) (ZIP Code) <br />(The following statement is adopted by marking the box.) <br />O✓ 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 Jeffery Schaaf Je John <br />(if an individual) ry <br />(Last) (First) (Middle) <br />or <br />(if an entity) <br />(Caution: Do not provide both an individual and an entity name.) <br />Mailing address 135 Meeker St. <br />Delta <br />(Street number and name or Post ice Box information) <br />CO 81416 <br />(City) (State) (ZIP /Postal Code) <br />United States. <br />(Province — it'apphcable) (Country) <br />(!f the following statement applies, adopt the statement by marking the box and include an attachment.) <br />FThe 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 />5. The management of the limited liability company is vested in <br />(Mark the applicable box.) <br />❑ one or more managers. <br />or <br />Qthe members. <br />6. (The following statement is adopted by marking the box.) <br />0 <br />✓ There is at least one member of the limited liability company. <br />7. (If the following statement applies, adopt the statement by marking the box and include an attachment.) <br />O✓ This document contains additional information as provided by law. <br />8. (Caution: Leave blank if the 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 />(If the following statement applies, adopt the statement by entering a date and, tf applicable, time using the required format.) <br />The delayed effective date and, if applicable, time of this document is /are <br />(Std -) <br />(nmt/dd/y yy hour. minute amlpm) <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 />