GENERAL55430

• Permit No: C1981013
• IBM Index Class Name: General Documents
• Doc Date: 4/3/2007
• Doc Name: Sec of State Information
• Permit Index Doc Type: General Correspondence
• Media Type: D
• Archive: No

Document processing fee
If document is filed on paper $100.00
[f document is filed electronically $ 10.00
Late fee if entity is in noncompliant status
If document is filed on paper $ 50.00
If document is filed electronically $ 20.00
Fees & forms/cover sheets
are subject to change.
To file electronically, access instructions
for this form/cover sheet and other
information or print copies of filed
documents, visit wwwsosstate.co.us
and select Business Center.
Paper documents must be typewritten or machi ne printed.
Colorado Secretary of State
Date and Time: 07/19/2006 09:04 AM
Id Number: 19871331143
Document number: 20061294442
ABOVE SPACE FOR OFFICE USE ONLY
Annual Report
filed pursuant to §7-90-301, et seq. and §7-90-501 of the Colorado Revised Statutes (C.R.S)
ID number:
Entity name:
Jurisdiction under the law of which the
entity was formed or registered:
You must complete line 1.
Notice:
19871331143
BASIN RESOURCES, INC.
Colorado
Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the
individual's act and deed, or that the individual in good faith believes the document is the act and deed of the
person on whose behalf the individual is causing the document to be delivered for filing, taken in conformity
with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic
statutes, and that the individual in good faith believes the facts stated in the document are true and the
document complies with the requirements of that Part, the constituent documents, and the organic statutes.
This perjury notice applies to each individual who causes [his document to be delivered to the secretary of
state, whether or not such individual is named in [he document as one who has caused it to be delivered. Stir \
1. Name(s) and address(es) of the ~ w Z.`,`t
individual(s) causing the document ~ ~~\
to be delivered for filing: Wlegley Roger D. ~ ~~
([asq (First) (Middle) (SuJJix) ~~S
2 North Cascade Ave
14th FIOO~treetname andnumber or Post Office Bax ircfarmation)
Colorado Springs CO 80903
(City) (Slate) (PastaUZip Code)
(Province-ifappBcableJ (Country-ifnot OSJ
(The document need not state the true name arcd address of more than one individual. However. if you wish m slate the name and address
ojany additional individuals causing the document to be delivered for filing, mark this box ^ and include an attachment stating the
name and address ojsuch individuals.)
REPORT Page I oft Rev. 3/8@006