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SENT E:,yrMSHG-CMS&H-Dist. 9 tJ3-16-92 82:18PM 3@32315553-3C0 MINED LGND REC'L q 5 <br />e:.! <br />?. Partnership Principal (1ff(ce Address (street( ~~ 3. City _ ~~ ~~ <br />4. Sieie 6. Zip o a <br />a. Nac,es of Fanners o. Street ndtlress c City d. State e. Zip Cnd T <br /> <br /> <br /> <br />section III. Cgrporeti0n <br />1. Ufficiat Corpdration Nema(51 2. Stets of Incorppration <br />3, Corporation Principal Offrce Address Istreetl 4. Clty 5. SCete B. Zip Cpd <br />T <br />a. Nemec of Corporation <br />pfficvrs and Directors p, 7i11e c. Street AddraES d. Citv e. State f, Zip Co <br /> <br /> <br />~ <br />7, Is Corporation a SpbEidiery7 <br />~ B. Name antl AtldreaE tYf Perant Corporation <br />Yes Q NO <br />If yes, give name and addrasS of parent <br />corporation. <br />Section IV. Other <br />t, Official tSusinaas Name of Oryenizetion 2. Type of Oryanlzation <br />3. Principal Office Address (Street) 4. City ~ $. StatO 8, Zlp CO <br />~ ~ ~ e <br /> <br />0. Names of Principal Organization <br />pfficials or Memtrtfs <br /> <br />h. Title <br /> <br />c. Street Address <br /> <br />a. City ti: <br />~'' ~r. " % <br />ate A:,'~', <br />tI <br />~:"'~, <br />„ G <br />r <br /> <br />B2 \' <br />~' ~ <br />9 <br /> ~r; <br />:. ~ <br /> ~~ <br />„ <br />~ <br /> <br />9, Names of Individuals with Ownership <br />I nterestE in Oryanization <br /> <br />h. Street Address <br /> <br />i. City ~ . <br />~ <br />j, Stote . <br />, <br />~ <br />k. Zip C <br /> <br />tle <br /> <br /> <br /> •~ 1 <br />~~ <br />~~ <br />