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ro I <br /> ® Colorado Secretary of State <br /> Date and Time: 12/08/2016 01:36 PM <br /> Document must be filed electronically. ID Number: 20161834572 <br /> Paper documents are not accepted. <br /> Fees&forms are subject to change. Document number: 20161834572 <br /> For more information or to print copies Amount Paid: $20.00 <br /> of filed documents,visit www.sos.state.co.us. <br /> ABOVE SPACE FOR OFFICE USE ONLY <br /> Statement of Trade Name of a Non-Reporting Entity <br /> filed pursuant to§7-71-103 and§7-71-107 of the Colorado Revised Statutes(C.R.S) <br /> 1. The person delivering this statement is an entity other than a reporting entity("non-reporting entity"). <br /> 2. (Adopt the appropriate statement by marling the box and complete the field.) <br /> Caution: Mark only one box.) <br /> Such non-reporting entity is a general partnership. <br /> The true name of at least one general partner of such general partnership is <br /> (if an individual) <br /> (Last) (First) (Middle) (Suffix) <br /> or <br /> (if an entity) <br /> (Caution: Do not provide both an individual and an entity name) <br /> or <br /> ✓�The non-reporting entity is not a general partnership and the true name of such non-reporting entity is <br /> All-Rite Paving & Redi Mix, Inc. <br /> 3. For such non-reporting entity delivering this statement,its form of entity and the jurisdiction under the law <br /> of which it is formed are <br /> Form of entity DBA <br /> Jurisdiction Colorado <br /> 4. The principal address of such non-reporting entity is <br /> Street address 839 Mackenzie Ave <br /> (Street number and name) <br /> Canon City CO 81212 <br /> (City) (State) (Postal/Zip Code) <br /> CO United States <br /> (Province—if applicable) (Country—if not US) <br /> Mailing address PO Box 566 <br /> (leave blank if same as street address) (Street number and name or Post Office Box information) <br /> Canon City CO 81215 <br /> (City) (State) (PostaWip Code) <br /> Colorado United States . <br /> (Province—if applicable) (Country—if not US) <br /> TRDN NRE Page 1 of Rev.12/01/2012 <br />