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This perjury notice applies to each individual who causes this document to be delivered to the Secretary of <br />State, whether or not such individual is named in the document as one who has caused it to be delivered. <br />9. The true name and mailing address of the individual causing the document to be delivered for filing are <br />schaaf jeffery john <br />(last) (First) (Middle) (Suffix) <br />135 Meeker St. <br />Delta <br />(Street number and name or Post Office Box information) <br />CO 81416 <br />(City) (state) (Z IP /Postal Code) <br />United States <br />(Province — ifapphcable) (Countrt) <br />(If the folloiring statement applies, adopt the statement by marking the box and include an attachment) <br />Q✓ This document contains the true name and mailing address of one or more additional individuals <br />causing the document to be delivered for filing. <br />Disclaimer: <br />This form /cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, <br />and are furnished without representation or warranty. While this form /cover sheet is believed to satisfy <br />minimum legal requirements as of its revision date, compliance with applicable law, as the same may be <br />amended from time to time, remains the responsibility of the user of this form /cover sheet. Questions should <br />be addressed to the user's legal, business or tax advisor(s). <br />