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4065316 12/01/20.14 04.32 PM <br /> Page 5 of 10 <br /> 7.Name(s)and address(es)of the <br /> individual(s)causing the document Seedt Sarah Niemiec <br /> to be delivered for tiling: <br /> (last) (First) (Middle) (StOx) <br /> 1200 17th Street <br /> Suite 2401StreetnanteanditttntberorPostOStceBoxinformation) <br /> Denver U CO 80202 <br /> (City) Un(fe"R'States (Posra""O'de) <br /> (Province—if applicable) (CotJnuy—if not Us) <br /> (The document need not state due true nanne and address of tnore than one individual. Hmvever,if you wish to state the mmne and address <br /> ofany additional individuals causing the document to be delivered for filing,,nark this box❑ and Include an attac/nnent stating the <br /> name and addressofsueh Individuals) <br /> Disclaimer: <br /> This form,and any related instructions,are not intended to provide legal,business or tax advice,and are <br /> offered as a public service without representation or warranty. While this form is believed to satisfy minimum <br /> legal requirements as of its revision date,compliance with applicable law,as the same may be amended from <br /> time to time,remains the responsibility of the user of this form, Questions should be addressed to the user's <br /> attorney. <br /> YD1J vJii Jli . f.lJ 3 t') ltF� t'i1�t i +�k <br /> i <br /> 1 <br /> mi <br /> q � <br /> f <br /> AMD—LLC rasa of 2 Rev.5i0112010 <br />