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i <br /> Form of entity Corporation <br /> Jurisdiction Colorado <br /> i <br /> Street address 839 Mackenzie Avenue <br /> (Sheet number and came) <br /> Canon City CO 81212 <br /> (City) (State) MP/Postal Code) <br /> (Provloce—if applicable) (Count <br /> Mailing address P.O. Box 841 <br /> (leave blank if same as street address) (Street)number and name or Past Office A x inforrrrarian) <br /> Canon City CO 81215 <br /> (Ciro) (State) (ZIP/Postal Code) <br /> (Province—if applicable) (Comdny <br /> 3. Each merging entity has been merged into the surviving entity. <br /> 4.(ffthe follmving statement applies.adopt the statement by marking the bon.) <br /> ❑ The plan of merger provides for amendments to a constituent filed document o the surviving entity and <br /> an appropriate statement of change or other document effecting the amendments will be delivered to the <br /> Secretary of State for filing pursuant to Part 3 of Article 90 of Title 7,C.R.S. <br /> 5.(lithe following statement applies,adopt the statement by mmkmg the box and state the appropriate docume t number(s)) <br /> ❑ One or more of the merging entities is a registrant of a trademark described in filed document in the <br /> records of the secretary of state and the document number of each filed docum nt is <br /> Document number <br /> Document number <br /> Document number <br /> (Ifthe following statement applies,adopt the statement by marking the box and include an attachment <br /> There are more than three trademarks and the document number of each additional trademark is <br /> stated in an attachment. <br /> 6. (lfapplicable,adopt the following s1wenrent by marking the bon and include an attachment.) <br /> ❑ This document contains additional information as provided by law. <br /> 7.(Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed ective date has significant <br /> legal consequences. Read instructions before entering a date.) <br /> (If the following statement applies,adopt the statement by entering a date and,if applicable,time using the re aired format.) <br /> The delayed effective date and,if applicable,time of this document are <br /> (mn✓d yyv hour:mbrute an✓pm) <br /> MERGE—DOM Page 3 of Rev.5/29/2007 <br /> I <br /> I <br /> II <br />