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u <br />4. (If applicable, adopt the following statement by marking the box.) <br />5. (If applicable, adopt the following statement by marking the box and include an attachment.) <br />❑ This document contains additional information as provided by law. <br />6. (Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has significant <br />legal consequences. Read instructions before entering a date.) <br />(If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required format) <br />The delayed effective date and, if applicable, time of this document are <br />Notice: <br />Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or <br />acknowledgment of each individual causing such delivery, under penalties of perjury, that such document is <br />such individual's act and deed, or that such individual in good faith believes such document is the act and deed <br />of the person on whose behalf such individual is causing such document to be delivered for filing, taken in <br />conformity with the requirements of part 3 of article 90 of title 7, C.R.S. and, if applicable, the constituent <br />documents and the organic statutes, and that such individual in good faith believes the facts stated in such <br />document are true and such document complies with the requirements of that Part, the constituent documents, <br />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 identified in this document as one who has caused it to be delivered. <br />7. The true name and mailing address of the individual causing this document to be delivered for filing are <br />NESBITT MARK T <br />(If applicable, adopt the following statement by marking the box and include an attachment.) <br />❑ This document contains the true name and mailing address of one or more additional individuals <br />causing the document to be delivered for filing. <br />Disclaim er: <br />Such registered agent has delivered notice of the change to the entity. <br />1700 Li ncol n St. <br />(First) <br />(Province — if applicable) (Country) <br />(mm /dd /yyyy hour: minute am/pm) <br />Ste. 2222 (Street number and name or Post Office Box information) <br />(Middle) (Suffix) <br />Denver CO 80203 -4522 <br />(City) tat) (ZIP /Postal Code) <br />Unifec� States <br />• <br />This form /cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, <br />and are furnished without representation or warranty. While this fotnl/cover sheet is believed to satisfy <br />minimum legal requirements as of its revision date, compliance with applicable law, as the same may be <br />amended from time to time, remains the responsibility of the user of this fot m/cover sheet. Questions should <br />be addressed to the user's legal, business or tax advisor(s). <br />CHANGE_RA_RESIGN Page 2 of 2 Rev. 10/6/2008 <br />