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-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 />Sig/~ned and dated thi s /y day of ~T, „ ~ /9r y . <br />v <br />plica.nt/Operator If Corporation Attest (Seal) <br />Title: C rpora a Secretary or Equivalent <br />Town/City/County Clerk <br />State of > <br />ss. <br />County of Lur(~l ) <br />The forego'i//ng instrument was acknowledged before me this S day of ~,~.-.,,r i9>"o? <br />by C~rlR~ld,/1 .fir. as ~!].;J.~~ of ,B~s/ K/.o..~v,:« ~o. <br />I ~ I ~ <br />otary Public ~ i,: <br />NyCommissiont~presdu~ycu, iy~ <br />My Commission Expires: <br />(08/91) 2823E <br />