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<br /> <br />-5- <br />• a I understand that statements in the application are being made under pena4ty <br />of perjury and that false statements made herein are punishable as a Cl <br />misdemeanor pursuant to Section 18-8-503, C.R.S. <br />:'~cned and dated this o'?6 day of Ufa/elv ,/9 <br />~QfliiQSi.Oec rcTe, ~n~ <br />=~='scant/Operator <br />-~ <br />iitlz: ,OYGt. <br />State or (.p~(~q~_) <br />ss. <br />Count y of ~~aaALd Q--) <br />If Corporation .a <br />By: <br />Corporate Secretary or Epuivalent <br />Town/City/County Clerk <br />'he foregoing instrument was acknowledged before me this a,3,tQ day o~`~,/(}")AR~nn~-_,/! JQQ~, <br />h as ,~/1PC~i~On/7~' Of ~~faa C;o/Vr-RoTa li/!; <br />~~ <br />Notary Public <br />My Commission Expires: l~-/~-~_ <br /> <br />(02/?2) 2823E <br />