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<br />BUSINESS <br />ENTITY <br /> <br />NATURE <br />OF ITS <br />ACTIVITY <br /> <br />NATURE OF <br />YOUR INTEREST <br />STREET OR ACTIVITY <br />ADDRESS IN BUSINESS <br /> <br />DO YOU HAVE A <br />CONTROLLING <br />INTEREST IN <br />THE BUSINESS? <br /> <br />7. state the location of any real property within Boulder county <br />in which you, or the business entities you have a controlling <br />interest in, have any interest. Also state the nature of <br />your, or your business entity's, interest. All interests, <br />including options, remainders, mineral rights, etc., no matter <br />what their value, must be listed. You need not state the <br />value of the interest, but you may if you wish. You need not <br />list your personal residence, but you may if you wish. <br /> <br />STREET ADDRESS <br />OF REAL PROPERTY* <br /> <br />INTEREST <br /> <br />THE INTEREST <br />A TRUST OF <br />WHICH I AM A <br />BENEFICIARY <br /> <br />BELONGS TO: <br />A BUSINESS <br />ENTITY I <br />CONTROL <br /> <br />* If there is no street address, state the lot number and <br />subdivision: if none, state the size of the parcel, the <br />quarter section it is in, and the recording number or other <br />place where the legal description can be found. <br /> <br />8. state any additional information which you desire to disclose. <br />If there is no such information, write "none." <br /> <br />Form date: July 13, 1992 <br /> <br />Page 3 of 4 <br />