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r <br />f <br />-5- <br /> <br />4. I understand that statements in the application are being made under pena;ty <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 />Signed and dated thi s ~/ day of T, ~ ~ !9~'L <br />plicant/Operator If Corporation Attest (Seal) <br />Title: C rpora a Secretary or Equivalent <br />Town/City/County Clerk <br />State of > <br />55. <br />County of l.~c.~~/ ) <br />The foregoing instrument was acknpowledged before me this S day of ~,o.,,.~ i9s'a <br />by ~<7R~lJ~ ll d'r. as /~ir.;J„~.~ of .~~s/- ~.t/,o~~v.;..~ coo. <br />otary Public ~ ,, <br />My Commissiont,ipuesdWy~u, iyyo <br />My Commission Expires: <br />(08/91) 2823E <br />