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988607 08/14/2023 01:21:56 PM Page 3 of 4 <br /> Jacklyn K. Harmon, Garfield County, Colorado <br /> Rec Fee: $28.00 Doc Fee: $0.00 eRecorded <br /> Form of entity Limited Liabilty Company <br /> Jurisdiction Colorado <br /> Street address 1001 17th Street <br /> Suite 1600 (Sa"et number and name) <br /> Denver CO 80202 <br /> (City) (State) (Z1P/Posud Code) <br /> (Province—irapplGnble) (Country) -- <br /> Mail ine address — <br /> (leave blank if same as street address) (Street number and name or Post Of"Box information) <br /> (City) (Stara) (WIPostal Code)--- <br /> (Province—((app/toaw (Corm fiJ <br /> 3. Each merging entity has been merged into the surviving entity. <br /> 4.(ifthe following statement applies,adopt the statement by morA*g 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.(lfthe following statement applies,adopt the statement by marking the box and state the appropriate document numbrrfs).) <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 /> (((the 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. (If applicable adopt the following statement by marking the box and include an atsochment) <br /> ❑ This document contains additional information as provided by law. <br /> 7.(Caution: !,love blank if the document does not have a delayed effective date Stating o delayed effective dale has significant <br /> legal consequences. Read insoucdons before entering a date.) <br /> (lfthe following statement applies,adopt the statement by entering a date and,ifappilcable,time using the required format) <br /> The delayed effective date and,if applicable,time of this document arc _ <br /> (mmldbyyyy hour.minute amlpm) <br /> MERGE_DOM Page 3 of 4 Rev.529/2007 <br />