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201301833 <br /> Co <br /> (City) (Stole) (ZIP Cade) <br /> (77re follmvm,g statement rc adopted by marking the bin ) <br /> 0 The person appointed as registered agent has consented to being so appointed. <br /> 4. 1 he true name and mailing address of the person forming the limited liability company are <br /> Name <br /> (if an individual) <br /> (Loot) (Fast) (1191i-idle) (Sufix) <br /> or <br /> (if an entity) Ascentia Real Estate Holding Company, LLC <br /> (Caution: Do not provide both an individual and an entity name) <br /> Mailing address 2 W DRY CREEK CIRCLE <br /> SUITE 20(Street number and name of Post Office BPI Wm matron) <br /> LITTLETON CO 80120 <br /> (Curl (State) (71P,Pactat Code) <br /> United States <br /> (Pros MCC-rl applicable) (Cornwell <br /> (If the hrllme ing slant Anent applies,adopt the stateme at by mucking the has and meta le an attachment) <br /> n The limited liability company has one or more additional persons forming the limited liability <br /> company and the name and mailing address of each such person are stated in an attachment. <br /> 5. The management of the limited liability company is vested in <br /> (Mark the applicable bus) <br /> Q one or more managers. <br /> or <br /> the members. <br /> 6. (The following statement rs adopted by marking the box.) <br /> 0 There is at least one member of the limited liability company. <br /> 7. at the fc tlmrmg statement applies adapt the statement ho marking the box and include an attachment <br /> n This document contains additional information as provided by law. <br /> 8. (Caution: Leave blank if the document does not have a delayed effective date Stating a delayed effective date has <br /> significant legal consequence.‘ Read instructions bef✓re entering a date <br /> (lIfthe follov mg statement applies,adapt the statement by enrerrng a date and.tf applicable.time rising the required format) <br /> The delayed effective date and, if applicable,time of this document is/are 01/01/2013 12:01 AM <br /> (nun/dd/tvyr hunt-'innate mrvpm) <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 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 he 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 /> ARTORG I I C Page 2 of Rev 12/01/2012 <br />