Fill and Sign the County of State of Colorado and Described as Form

NON-FOREIGN AFFIDAVIT UNDER INTERNAL REVENUE CODE SECTION 1445(b)(2) STATE OF COLORADO )COUNTY OF _________________) I/WE, ______________________________________________________________________, the "Seller(s)", being first duly sworn, state under penalties of perjury:1. That I/WE am/are the Transferor(s) of the property located at __________________________________________________________________ , in the City of ____________________________, County of _________________, State of Colorado, and described as follows:District ___________ Section ___________ Block ___________, Township ______, Range ________ or Parcel Number ___________________________________ 2. That my/our United States taxpayer identification number is/are:Seller: _____________________________ Tax ID: _________________________ Address: ___________________________________________________________ City ________________ State_______ Zip__________Seller: _____________________________ Tax ID: _________________________ Address: ___________________________________________________________ City ________________ State_______ Zip_________ Seller: _____________________________ Tax ID: _________________________ Address: ___________________________________________________________ City ________________ State_______ Zip_________Seller: _____________________________ Tax ID: _________________________ Address: ___________________________________________________________ City ________________ State_______ Zip__________ 3. That I/WE am/are not a "foreign person" as that term is defined in Section 1445(f) of theInternal Revenue Code.This affidavit is given to ___________________________________________________, the "transferee(s) or Buyer(s)" of the property described in paragraph 1 above for the purpose of establishing and documenting the non-foreign affidavit exemption to the withholding requirement of Section 1445 of the Internal Revenue Code.__________________________________________________________________________________________________Seller Date Seller Date___________________________________________________ _______________________________________________Seller Date Seller DateSworn to and Subscribed before me this the _________ day of __________________, 20______.My Commission Expires: _______________________________________ NOTARY PUBLIC ________________________