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i <br />-5- <br />4. 1 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 1 <br />misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this "Z- G day of , R lL , J I 4 (-. <br />Applicant/Operator <br />1 By 0 t�2 <br />Title: lip <br />i <br />State of eo 049:10 ) <br />) ss. <br />County of t �iWrSOA/ ) <br />If Corporation Attest (S A1)_ <br />By: <br />C porate ecretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me thi�,Piday of /3fA) L , <br />by /%%ART7A Q..%ONC.S as JIP 65�yGk� of � 661rww A66-ecz .� <br />2n� . <br />�ONary Public <br />My Commission Expires: <br />12823F (02/05193) <br />n <br />