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6. Registered agent mailing address: <br />(if different from above) <br />(Street name and number or Post pffce Box information) <br />(City) (State) (Postd&Zip Code) <br />(Province - i(applicable) (Country- if not US) <br />Notice: <br />Causing this document to be delivered to the secretary of state for filing shall constitute the affiimation or <br />acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the <br />individual's act and deed, or that the individual in good faith believes the document is the act and deed of the <br />person,on whose behalf the individual' is causing the document to be delivered for filing, taken in conformity <br />with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic <br />statutes, and that the individual in good faith believes the facts stated in the document are true and the <br />document complies with the requirements of that Part, the constituent documents, and the organic statutes. <br />This perjury notice applies to each individual who causes this document to be delivered to the secretary of <br />state, whether or not such individual is named in the document as one who has caused it to be delivered. <br />7. Name(s) and address(es) of the <br />individual(s) causing the document <br />to be delivered for filing: Koktavy Douglas D. <br />(Last) (First) (Mid&e) (Suffix) <br />Suite 200 <br />(Street name and number or Post ice Box information) <br />3515 S. Tamarac Drive <br />Denver CO 80237 <br />(City) (Jnlfa States MostalOpCode) <br />(Province -ifapplicable) (Country-if not us-) <br />('The document need not state the true name and address of more than one individual. However, if you wish to state the name and address <br />of any additional individuals causing the document to be delivered for filing, mark this box ? and include an attachment stating the <br />name and address of such individuals.) <br />Disclaimer: <br />This form, and any related instructions, are not intended to provide legal, business or tax advice, and are <br />offered as a public service without representation or warranty. While this form is believed to satisfy minimum <br />legal requirements as of its revision date, compliance with applicable law, as the same may be amended from <br />time to time, remains the responsibility of the user of this form. Questions, should be addressed to the user's <br />attorney. <br />REPORT <br />Page 2 of 2 <br />Rev. 510112010