CORRECT SOFEA Page 1 of 2 Rev. 11/14/2017 Document processing fee If document is filed on paper $150.00 If document is filed electronically Not available For more information or to print copies of filed documents, visit www.sos.state.co.us . Must be typewritten or machine printed. ABOVE SPACE FOR OFFICE USE ONLY Statement of Correction Correcting a Mistakenly Filed Domestic Entity that was meant to be a Foreign Entity filed pursuant to 2477 - 90 - 305 of the Colorado Revised Statutes (C.R.S .) 1.For the entity, its ID number, entity name, and true name, if applicable, are ID number (Colorado Secretary of State ID number) Entity name . 2.The document number of the filed document being corrected is . 3. The correct Statement of Foreign Entity Authority document is attached. 4 . This document contains additional information as provided by law. Notice: Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or acknowledgment of each individual causing such delivery, under penalties of perjury, that such document is such individual's act and deed, or that such individual in good faith believes such document is the act and deed of the person on whose behalf such individual is causing such document to be delivered for filing, taken in conformity with the requirements of part 3 of article 90 of title 7, C.R.S. and, if applicable, the constituent documents and the organic statutes, and that such individual in good faith believes the facts stated in su ch document are true and such document complies with the requirements of that Part, the constituent documents, and the organic statutes. This perjury notice applies to each individual who causes this document to be delivered to the Secretary of State, wh ether or not such individual is identified in this document as one who has caused it to be delivered. 5 .The true name and mailing address of the individual causing this document to be delivered for filing are (Last) (First) (Middle) (Suffix) (Street number and name or Post Office Box information) American LegalNet, Inc. www.FormsWorkFlow.com CORRECT SOFEA Page 2 of 2 Rev. 11/14/2017 (City) (State) (ZIP/Postal Code) (P rovince if applicable) (Country) (If the following statement applies, adopt the statement by marking the box and include an attachment.) This document contains the true name and mailing address of one or more additional individuals causing the document to be delivered for filing. Disclaimer: This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, and are furnished without representation or warranty. While this form/cover sheet is believed to satisfy minimum legal requirements as of its re vision date, compliance with applicable law, as the same may be amended from time to time, business or tax advisor(s). American LegalNet, Inc. www.FormsWorkFlow.com AUTHORITY Page 1 of 3 Rev. 1 1 / 14 / 2017 This document must be filed with the statement of correction. ABOVE SPACE FOR OFFICE USE ONLY Statement of Foreign Entity Authority filed pursuant to 247 7 - 90 - 803 of the Colorado Revised Statutes (C.R.S.) 1. The entity ID number, the entity name, and the true name, if different, are Entity ID number (Colorado Secretary of State ID number) Entity name . True name (if different from the entity name) . 2. The form of entity and the jurisdiction under the law of which the entity is formed are Form of entity Jurisdiction . Street address (Street number and name) (City) (State) (ZIP/Postal Code) (Province if applicable) (Country) Mailing address ( leave bl ank if same as street address) (Street number and name or Post Office Box information) (City) (State) (ZIP/Postal Code) . (Province if applicable) (Country) 4. The registered agent name and r Name (if an individual) (Last) (First) (Middle) (Suffix) or American LegalNet, Inc. www.FormsWorkFlow.com AUTHORITY Page 2 of 3 Rev. 1 1 / 14 / 2017 (if an entity) . ( Caution: Do not provide both an individual and an entity name.) Street address (Street number and name) CO (City) (State) (ZIP Code) Mailing address ( leave blank if same as street address) (Street number and name or Post Office Box information) CO . (City) (State) (ZIP Code) ( The following statement is ad opted by marking the box.) The person appointed as registered agent above has consented to being so appointed. 5. The date the entity commenced or expects to commence transacting business or conducting activities in Colorado is . (mm/dd/yyyy) 6. (If applicable, adopt the following statement by marking the box and include an attachment.) This document contains additional information as provided by law. 7. ( Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has significant legal consequences. Read instructions before entering a date.) (If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required forma t.) The delayed effective date and, if applicable, time of this document is/are . (mm/dd/yyyy hour:minute am/pm) Notice: Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the individual's act and deed, or that the individual in good faith believes the document is the act and deed of the person on whose behalf the indiv idual is causing the document to be delivered for filing, taken in conformity with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic statutes, and that the individual in good faith believes the facts stated in the document are true and the document complies with the requirements of that Part, the constituent documents, and the organic statutes. This perjury notice applies to each individual who causes this document to be delivered to the Secretary of State, whether or not such individual is named in the document as one who has caused it to be delivered. 8. The true name and mailing address of the individual causing the document to be delivered for filing are (Last) (First) (Middle) (Suffix) (Street number and name or Post Office Box information) American LegalNet, Inc. www.FormsWorkFlow.com AUTHORITY Page 3 of 3 Rev. 1 1 / 14 / 2017 (City) (State) (ZIP/Postal Code) (Province if applicable) (Country) (If the following statement applies, adopt the statement by marking the box and include an attachment.) This document contains the true name and mailing address of one or more additional individuals causing the document to be delivered for filing. Disclaimer: This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, and are furnished without representation or warranty. While this form/cover sheet is believed to satisfy minimum legal requirements as of its r evision date, compliance with applicable law, as the same may be amended from time to time, remains the responsibility of the user of this form/cover sheet. Questions should be addressed to American LegalNet, Inc. www.FormsWorkFlow.com Business Information Survey (Optional) For office use only Submit with your form if you want to add , change , or remove survey information Survey information can be added, changed, or removed when you file a form with our office . - it does not become a part of the document that you file with us. Th is survey is voluntary. Any information that you enter will be available to the public. The information is being gat hered as required by law - see House Bill 13 - 1167 for information. Entity information ID number E ntity name Choose one: 1. Remove all survey information from this 2. Add or update the survey information on this a) Gender Male Female Choose not to answer / Remove this information b) Veteran? Yes No Choose not to answer / Remove this information c) Person with a disability? Yes No Choose not to answer / Remove this information d) Race African American Latino Anglo Native American Asian Other Choose not to answer / Remove this information SurveyInf