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AFFIRt~tATION OF COLORADO RESIDENCY <br />I (we) hereby affirm that I am (we are) the transferor(s) or the fiduciary of the transferor of the property <br />described on the front side of this form and that as of the da[cof closing I am (we are) or the estate or [he trust <br />': is a resident of the State of Colorado. <br />Signed under the penalty of perjury: ' <br />signamrc oflnnsfcmrorfiduciary Rd Nix P uce, Inc. a Co lorado~ ~ Dmc <br />C porn i IyY: Ralph Nix, President ~- <br />OA~ 3~~( <br />Spauae uignaNrc inapplicable Y: rrv Nix, Vice-President m. <br />AFFIRMATION OF PERMANENT PLACE OF BUSINESS <br />I hereby affirm that the transferor of the property described on the front side of this form is a corporation <br />which maintains a permanent place of business in Colorado ora partnership which staffs and maintains a <br />permanent office in the State of Colorado.. <br />'Signed under the penalty of perjury: <br />Signature of <arponn o!(ieer or general panner <br />AFFIRMATION OF PRINCIPAL RESIDENCE <br />I (we) hereby affirm that I am (we aze) [he transferor(s) of the property described on the front side of [his <br />form and immediately prior to the transfer it was my (our) principal residence which could qualify for the roll <br />over of gain provision of section 1034 of the internal revenue code. <br />Signed under the penalty of perjury: <br />a <br />Signnun or tnmfcnr Dme <br />Spouse's siynaturc if applicable Dan <br />AFFLRt~IATION OF NO REASONA$LY ESTIMATED TAX Tb BE DUE <br />I (we) hereby affirm that I am (we aze) the transferor(s) or an officer of [hecorporate-transferor or a fiducian <br />of the estate ortrust-transferor of the property desctbed on [he front side of this form, and I (we) further <br />affirm that there will be no Colorado income tax reasonably estimated to be due on the par[ of the <br />transferor(s) as the result of any gain realized on the transfer. IF a partnership is held to be the transferor. 1 <br />affirm that I am the general partner and that there will be no gain on the sale recognized for federal income <br />tax purposes. <br />Please understand before you sign this affirmation that nonresidents ojColorado are subject to <br />Colorado tar on gains from the sale of Colorado real estate to the extent sttrlt gains are included in <br />federal !arable income. <br />i <br />Signed under the penalty of perjury: <br />Signaturo(Uansfcror, ofneer, GCuciary or gennlpanna - Dan <br />