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100 seed o AjejaMS apos0100 -01 <br />012MOS0B -190ld uolte80 tooe- t0 -AoN peniscsb <br />Thin podury notico applios to moh individual who eausca this document to be delivered to the aecrotary of <br />sblte, whether or not M►rh individual is named in the document as one who has caused it to be delivered. <br />11. Name(s) and address(es) of the <br />Individual(s) causing the document <br />to be delivered for Ming; Kce= Jeffrey H. <br />7400 E. Coley Ave- Suite 300 (Frrsr) (Mlddla) (Suffix) <br />(b reername ananumber or PosrO)TX4 Vox OPMMan) <br />Englewood Cu. 80111 <br />(( OO M-10 (PordaMP LVd0) <br />MMVInam trupphrah►a) ((Seunrry_ frPinr M) <br />(Vic doemnenr need !tor awe the flue name and addrads ofinam rlmn ate lndtddaut Nmu .war, ifynv wish m Stara, tha nmuv mud addrps> <br />ofonyadduionnl individuals caudng dea document to be defivavd forJllins mark this baxDmul Guhtda ml amuJuneuualcohIS dha none <br />andaddtray ofmdch aurmduaft ) <br />Disclaimer: <br />This form, and any related instructions, are not intended to provide legal, bualnes3 or tart advice, rand am <br />offered as &public service without representation orwatrdnty. While thin form is helievrA rn antisfy mniuim im <br />legal requirementa as of its revision date, complinncea wjih applIuablG law, as the Name maybe amended from <br />time i n time, mmain; As responsibility of the user of this fonn. Questions should be addressed to iho a eea <br />attvtnay, <br />Rev 7!13/2004 <br />4hM <br />L00lA Z Q A OL£6768£O£ Sifts 80:90 VOOZ /T0 /TT <br />