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07-09-'21 08:39 FROM- T-380 P0004/0006 F-200 <br /> Form of entity Corporation <br /> Jurisdiction Colorado <br /> Street address 2273 River Road <br /> (Street number and name) <br /> Grand Junction co 81515 <br /> (city) U,jSnt1ate) (ZIP/Postal code) <br /> (Province—ifapplicable) (Cot.ntry) <br /> Mailing address <br /> (leave blank if same as street address) (Srreat number and name or Past Of ce Box informadan) <br /> (City) (Sate) (Zlplpostal Code) <br /> (Province—ifapplicable) (Comrhy) <br /> 3. Each merging entity has been merged into the surviving entity. <br /> 4.(!f the following statement applier,adopt the statenreat by marking the box.) <br /> ❑ The plan of merger provides for amendments to a constituent filed document of 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.(Ijthefal/mrdng statement applies,adopt the statement by umrking the bar and state the appropriate doctmrenl munber(s).) <br /> ❑ One or more of the merging entities is a registrant of a trademark described in a filed document in the <br /> records of the secretary of state and the document number of each filed document is <br /> Document number <br /> Document number <br /> Document number <br /> (!f the jollowing statement applies,adopt the statement by umrking tyro 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. (7f applicable,adopt thefollowing statement by marking the box and Include ao a+rachmenr) <br /> ❑ This document contains additional information as provided by law. <br /> 7.(Cannon: heave blank ffthe document does not have a delayed effective date. Stating a delayed effective dare has significant <br /> legal consequences. Read inductions before entering a date.) <br /> (If the following Statement appliet,adopt the statentetu by entering a date and,if applicable,time using the required format.) <br /> The delayed effective date and,if applicable,time of this document are <br /> (nunlddlyyyy!torn-:minute ant/pm) <br /> MERGE DOM Pagt 3 of 4 Rev.5/29/2007 <br />