COLORADO SECRETARY OF STATE Payment is required with request. REQUEST FOR OATH OF OFFICE OR FACSIMILE SIGNATURE FILING Type of document (check one): Oath of Office Facsimile Signature Filing Name(s)/Title on document: ___________________________________________________________ Office held: Jurisdiction: ___________________________________________________________ ___________________________________________________________ Most current date OR Date range: _______________________________________________ Indicate standard of service requested: Regular OR Expedite (add $10 per copy to the regular fee) Regular fee Fee if expedited $15.00 per copy Certified copy Number of copies: ___________ $5.00 per copy Photocopy only Number of copies: ___________ Free $10.00 per copy Make checks payable to: Colorado Secretary of State REQUESTING PARTY Name: __________________________________________ Phone: ___________________________ Address: __________________________________ City: _________________ State: ______ ZIP ___________ Mail Pick up Fed Ex/UPS Account Number: ______________________________ Prepaid Account Number: ________________________ Job Number: ________________________ OF_ORDER Page 1 of 1 Rev. 1/25/2011 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