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4065316 12/01/20.14 04:32 PM <br /> { Page 5 of 10 <br /> 7.Namc(s)and address(os)of the <br /> individual(s)causing the document Seedig Sarah N(emiec <br /> to be delivered for filing: <br /> (Last) (Plrst) (Middle) (SWIT) <br /> 1200 17th Street <br /> Suite 240PtinanieandntinlberorPostCjiceBaxinforvnadon) <br /> Denver CO 80202 <br /> (city) UntNalstates (PostaUZlP") <br /> (Province—fjapplicable) (Counhy—lfrtot US) <br /> (The document need not state die trite name and address of snore than one Individual. Hmcever,if you wish to state the name and address <br /> ofan)-additional Individuals causing the document to be delivered forming,stark thls bar❑ and Include an attadiment staling the <br /> narne and address ofsuch lndlvkhols.) <br /> Disclaimer: <br /> This forts,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 /> j(.t..� s�,}r-t,`1t l�n ,. �...✓..� <br /> Fh lid+sl f1t1(�.si„iRi)Utt,f:i;,�•'.•titij''r:9f�f <br /> ;rt•1 fit;�" r;},r "� �+� <br /> •3II�Yo b'i�}`r�i;�... ......—_._ )•t .fUtra2iir0 t <br /> ybw"9t on,t}; .;aI ;tt gsnt:+t;.a?t)l'>r.r,r•);} 1 o <br /> 1r;a <br /> j !}1c+tG ir]•,�,{)1a.;�:1:.1[: ,ter <br /> AMD-d.0 Page 2 of 2 Rev.SI01I2010 <br />