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-5- <br /> 4. I understand that statements in the application are being ma a under penalty <br /> of perjury and that false statements made herein are punishable as a Class 1 <br /> misdemeanor pursuant toSection 18-8-503, C.R.S. <br /> Signed and dated this day of LLut -; <br /> ad <br /> pplicant/Operato If Corporation At est (Sea?3 <br /> By: By: 440-,Or..�� <br /> Title: Corporate Secre ary or Equi Olent <br /> Town/City County Clerk <br /> State ofZci ) <br /> > ss. <br /> County of <br /> The foregoing instrument was acknowledged before me this <Oday of L7 <br /> by m �- as J= —/Ata of y /-ShX� <br /> Notary Public <br /> My Commission Expire <br /> 2823F (02/05/93) <br />