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98860-f 08/14/2023 01:21:56 PM Page 4 of 4 <br /> Jacklyn K. Harmon, Garfield County, Colorado <br /> Rec Fee: $28.00 Doc Fee: $0.00 eRecorded <br /> Notice: <br /> Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or <br /> acknowledgment of each individual causing such delivery,under penalties of perjury,that such document is <br /> such individual's act and deed,or that such individual in good faith believes such document is the act and deed ' <br /> of the person on whose behalf such individual is causing such document to be delivered for filing,taken in <br /> conformity with the requirements of part 3 of article 90 of title 7,C.RS.and,if applicable,the constituent <br /> documents and the organic statutes,and that such individual in good faith believes the facts stated in such <br /> document are true and such doctuncrit complies with the requiremerits of that Part,the constituent documents, <br /> and the organic statutes. <br /> This perjury notice applies to each individual who causes this document to be delivered to the Secretary of <br /> State,whether or not such individual is identified in this document as one who has caused it to be delivered. <br /> 8. The true name and mailing address of the individual causing this document to be delivered for filing are <br /> Woolston Allison _ <br /> 1001141treet �-0 (Mrddlej -- � <br /> Suite 160retnrmberondeameorPox Office Bazb*rmatloa <br /> Denver CO 80202 <br /> (City) (Spote) inplPostal Code) <br /> (ProWnee—#applicable) (Cornlry) <br /> (lfopplicable.adopt the following rratemenr by rnarkng the box and include an arrachmew) <br /> ❑ This document contains the true name and mailing address of one or more additional individuals <br /> causing the document to be delivered for filing. <br /> Disclaimer: <br /> This form/cover sheet,and any related instructions,are not intended to provide legal,business or tax advice, <br /> and are furnished without representation or warranty. While this form/cover sheet is believed to satisfy <br /> minimum legal requirements as of its revision date,compliance with applicable law,as the same may be <br /> amended from time to time,remains the responsibility of the user of this form/cover sheet. Questions should <br /> be addressed to the user's legal,business or tax advisor(s). <br /> MERGE_DOM Page 4 of A Rev.529rI007 <br />