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• <br />1 <br />1 <br />1 <br />-5- <br />4. I 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 7-6 day of /QIPR 1L , ! i1 9. <br />4,)- si C a,i/ <br />Applicant/Operator If Corporation Attesit CSoIl)_ -. <br />By: <br />Title: <br />State of e.L Ot.f4ZtO ) <br />) ss. <br />County of d%=�yolDi1/ ) <br />porate ecretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this .day of /9/AIL- , /f9y <br />by /771^/!2. 7&'L 5 as l�/61 6:61/ l%71l1' of WeSrfeN /964,e64097-756 <br />Talmo <br />2823F (02/05/93) <br />.1 <br />frry Public <br />My Commission Expires: %% /0 =9Ye <br />