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. . 201301833 <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 /> 9 The true name and mailing address of the individual causing the document to be delivered for filing are <br /> Wallen Kip Michael <br /> (Last) (first) (,4Ld4e) (Snfs) <br /> 1900 Wazee Street Suite 300 <br /> (Sher,munhrn rind name or Post Office Box information) <br /> Denver CO 80202 <br /> (Cm) (State) (LIP/Postal Code) <br /> United States <br /> (Province—if applicable) (Corinna) <br /> (If the follownig comment applies.adopt the statement by marking the hoe 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 /> Disclaimer: <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 form/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 form/cover sheet. Questions should <br /> be addressed to the user's legal, business or tax advisor(s). <br /> I <br /> q " —. <br /> 4 OCIA1;10.10'a 7031'ekTe 1 <br /> til A <br /> tp YtEo evil ti i! 2'i1'S'it �,lS9; td7:ti r it '; r a ^„e, v <br /> nih tr•3T%t!tQt2 �i ° F 41�A- • <br /> 0 i midi,"J •7 hric.'3`, %It to y` <br /> ,, 4rIPS t• * <br /> I y <br /> I <br /> ARTORci LLC Pnge 3 of 3 Rev 12/0112012 <br />