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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 />Marolf Karyn <br />(Last) (First) (Middle) (Suffix) <br />650 Mountain View Lane <br />(Street number and name or Post Office Box information) <br />Norwood CO 81423 <br />(City) (State) (ZIP /Postal Code) <br />United States <br />(Province — tfapplicable) (Country) <br />(Ifthe following statement applies, adopt the statement by marking the box and include an attachment) <br />❑ 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 />ARTORG_LLC Page 3 of 3 Rev 12/01/2012 <br />