Document processing fee Certification fee Expedite fee (same day service) Fees & forms/cover sheets are subject to change. $10.00 $ 5.00 $10.00 FACSIMILE SIGNATURE CERTIFICATE Title 11 - Article 55 STATE OF COLORADO COUNTY OF ____________________________ On this day, ________________________________, personally appeared before me, the undersigned (Print name of person appearing) authority, and, known to me and being by me duly sworn upon his/her oath, deposed and said: 1. That he/she is the duly and lawfully appointed, qualified, sworn and acting officer of ____________________________________________________________________________ ____________________________________________________________________________. 2. That the signature appearing below is his/her own manually executed signature in the form and manner used to execute all official documents in my official capacity, hereinabove designated. 3. That hereto affixed is an impression of the official seal of _______________________ County, Colorado as the same has been authorized and used for official documents. (S E A L) ___________________________________ SIGNATURE _____________________________ TITLE Subscribed and sworn to before me this ______ day of _________________, 20_____. ______________________________ Notary Public (S E A L) FACS Page 1 of 1 Rev. 1/01/2011 American LegalNet, Inc. www.FormsWorkFlow.com Mail form with correct payment to: Colorado Secretary of State 1700 Broadway Ste 200 Denver, CO 80290 Make checks payable to: Colorado Secretary of State Include a separate check for each form submitted for filing. If a document is rejected, this will allow us to return the check at the time of rejection (if applicable). The document can be corrected and resubmitted with the returned check. Checks must be written for the exact amount or the document may be rejected and returned. Do not include this page with your filing. American LegalNet, Inc. www.FormsWorkFlow.com