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<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 ~~.(,~JL ~~9~ <br />Applicant/Operator <br />By: N L. ~os~~l <br />Title: <br />State of ~~ ) <br />> ss. <br />County of CL ~ ) <br />If Corporation Attest (Seal) <br />By: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing Instrument was acknowledged before me this a 7 day of ate- , l~~3 <br />by as !~uf1~ ~~r~D,!-i~ of ,~0/Yt.Q,ta Q/Y~.~d)I~,~QN1c, <br />~ '•• <br />~~~,=,•`~ .~~~~.`': ~'_ Notary Public <br />~~ t':1`~~'~~.cQY <br />My Commission Expires: ~ d S <br />2823E (02/05/93) <br />