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12.(Optional) Delayed effective date: <br /> (nun/ddlvsti•s•) <br /> 13.Additional information may be included pursuant to other organic statutes such as title 12,C.R.S. If <br /> applicable,mark this box ❑ and include an attachment stating the additional information. <br /> Notice: <br /> Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or <br /> acknowledgment of each individual causing such delivery,under penalties of perjury,that the document is the <br /> individual's act and deed,or that the individual in good faith believes the document is the act and deed of the <br /> person on whose behalf the individual is causing the document to be delivered for filing,taken in conformity <br /> with the requirements of part 3 of article 90 of title 7,C.R.S„the constituent documents,and the organic <br /> statutes,and that the individual in good faith believes the facts stated in the document are true and the <br /> document complies with the requirements of that Part,the constituent documents,and the organic statutes. <br /> 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 /> 14.Name(s)and address(es)of the <br /> individual(s)causing the document <br /> to be delivered for filing: MUlliken Steven K. <br /> (Last) (Firsr) (Middle) (Suffix) <br /> 102 S. Tejon Street, Suite 900 <br /> (.Street name and number or Ant Office Box information) <br /> Colorado Springs CO 80903 <br /> (City) UrM'States (Posral2ipCale) <br /> (Province-if applicable) (Counin•-if not US) <br /> (The document need not mate the true name and address of more than one individual. However,if you wish to state the name and address <br /> of any additional Individuals caumng the document to be delivered for filing,mark this box ❑ and include an attachment stating the <br /> name and address of such 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 /> ARTORG-1-1.0 Page 3 of 3 Rev,1 1/1 612005 <br />