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<br />-5- <br />Affidavit <br />Applicant, or duly authorized representative, being first duly sworn, states to the best of Applicant's <br />knowledge and belief, that the information furnished is correct and complete. <br />Date: ~ / /• /J By ~/~~~%f~--~ <br />(Applicant) <br />State of ~n~or~ ~o ) <br />n ) ss. <br />County of (-, U n n I so >7 <br />Subscribed and sworn before me this ~ day of <br />~~, <br />by~obPr)- WPoVe.~ as no~llc~h+ <br />Notary Public C~ ~ .do- <br />My Commission Expires: <br />MY COMMISSION EXPIRES: Feb, /, 1998 <br />JIS S. Telkr <br />Gunnison, Colorado BI210 <br />