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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 hereto are punishable as a Class 1 <br />misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this 1L~day of l/ i ,~• <br />Applicant/Operator <br />ey: ~ ~ ~ ! C•' l~C <br />Title: ~-~ - -~ <br />State of c~~..~,~,w.L+-~ ) <br />> ss. <br />County of ~ > <br />If Corporation Attest (Seal! <br />Corporate Secretary or Equivalent <br />Town/City/County Clark <br />The foregoing inst+ument was ackno !edged ¢efore me this /!'day of ' i49 <br />by s .~ r ~ -,~L of /~~ ~ / .. <br />Y~-/</L GO~t~ L~f..f//~ <br />Notary Public <br />My Commission Expires: <br />My CamNssbn 6tpires 2/7J98 <br />(04!92) 2823E <br />