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.. ~ r <br />-5- <br />4. I.understand that statements in the application are being made under penalty <br />of perjury and that false statements made herein are punishable as a Class 1 <br />misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this ~ day of ~ ~~_ <br />Applicant/Operator <br />By: <br />Title: <br />State of C~ > <br />> ss. <br />County of ~~ b > <br />If Corporation Attest (Seal) <br />By: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The f e oin ins rument as ackn ~ LZ <br />//pp-1~~r,,g g hedged before me thls~~da f C/~! <br />by ~lYl(~IYIGd .~ l.lba1r.~ as of Cu ~ <br />~~~M l ,c~c~~0.~~ c ~ <br />Notary Puhlic / <br />-_ , _ My Commission Expires: ~~ ~C ~ 3 <br />(04/92) 2823E <br />