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_j. ~ - -~ - <br /> <br />-5- <br />4. I understand that statements in the application are being made under penalty <br />of per]ury 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 ~Sc~. <br />App cant/Operator <br />By• <br />Ti t <br />If Corporation Attest (Seal)_ <br />~~~~ <br />Corporate Secretary or Equivalent <br />TownlCity(County Clerk <br />State ofC,w-G~~y ) <br />ss. <br />County of ) <br />hJe~ foreg ng instrument was acknowledged before me thi~°0%day u~vi <br />C-~-$'~.~ ~~oi as~ ~i~iu-oco~,~i of dw,~,o <br />Notary Public <br />My Commission Expires• .~/~ <br />~~ ii <br />(08/91) 2823E <br />