2024-07-23_REVISION - M2000144

• Permit No: M2000144
• IBM Index Class Name: Revision
• Doc Date: 7/23/2024
• Doc Name: Request For Succession Of Operator
• From: BURNCO Colorado LLC
• To: DRMS
• Email Name: NCG
• Email Name: JLE
• Email Name: SMS
• Media Type: D
• Archive: No

Jurisdiction
Street address
(Street number and name)
(City) (State) (Z/P/P-lal Code)
(Province-if applicable) (Country)
Mailine address
(leave blank if same as street address) (Street number and name or Post Office Box information)
(City) (State) (71PIPostal code)
(Province-if applicable) (Country)
ID Number
(Colorado Secretary of State 1D number)
Entity name or true name
Form of entity
Jurisdiction
Street address
(Street number and name)
(City) (State) (ZIP/Postal Cade)
(Province-if applicable) (Country)
Mailing address
(leave blank if same as street address) (Street number and name or Pact Office Box information)
(City) (Smte) (5P/Postal Code)
(Province-if applicable) (Country)
(Ifthe follorvUig statement applies.adopt the staxmtent by marking the box and include an attachment.)
❑ There are more than three merging entities and the ID number(if applicable),entity name or true
name,form of entity,jurisdiction under the law of which it is formed,and the principal address of
each additional merging entity is stated in an attachment.
2. For the survivin entity which is a foreign entity,its entity ID number(if applicable),entity name or true
name,form of entity,jurisdiction under the law of which it is formed,and principal address are
(Caution: The surviving entity cannot be an entity formed under the laws of Colorado.)
ID Number 20171214623
(Colorado Secretary of State ID number)
MERGE FGN Page 2 Rev.5/29/2007