CURE_DLQ
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Rev. 5/01/2010
Document must be filed electronically.
Paper documents will not be accepted.
Document processing fee
$100.00
Fees & forms/cover sheets
are subject to change.
To access other information or print
copies of filed documents,
visit www.sos.state.co.us
Statement Curing Delinquency
and
select Business.
ABOVE SPACE FOR OFFICE USE ONLY
filed pursuant to §7-90-904 of the Colorado Revised Statutes (C.R.S)
1. For the delinquent entity, its ID number, entity name and jurisdiction of formation are
ID number
_________________________
(Colorado Secretary of State ID number)
Entity name
______________________________________________________
Jurisdiction where formed
______________________________________________________.
2. By providing the information required herein, this statement corrects all grounds for delinquency cited by
the secretary of state.
3. The registered agent name and registered agent address of the registered agent are
Name
(if an individual)
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
OR
(if an entity)
______________________________________________________
(Caution: Do not provide both an individual and an entity name).
The person appointed as registered agent above has consented to being so appointed.
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)
(If the following statement applies, adopt the statement by marking the box.)
The mailing address in the records of the Secretary of State is no longer different than the street
address and is no longer required.
Colorado
Suite 310
John
Snow
20081128042
80202
Denver
1601 Blake St.
Po Slovensky Holdings, LLC
Thomas
Colorado Secretary of State
Date and Time: 11/21/2010 08:43 PM
ID Number: 20081128042
Document number: 20101636545
Amount Paid: $100.00
Statement Curing Delinquency — Po Slovensky Holdings, LLC, ID 20081128042 (2010)
Document text
CURE_DLQ
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Rev. 5/01/2010
4. The principal office address of the entity’s principal office is
Street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable) (Country – if not US)
Mailing address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________.
(Province – if applicable) (Country – if not US)
(If the following statement applies, adopt the statement by marking the box.)
The mailing address in the records of the Secretary of State is no longer different than the street
address and is no longer required.
5. (If the following statement applies, adopt the statement by marking the box and include an attachment.)
This document contains additional information as provided by law.
6. (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 format.)
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 individual 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.
7. 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)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________.
(Province – if applicable) (Country – if not US)
228 W. 71st Street
Denver
10023
New York
80202
United States
NY
United States
Hurd
Suite 310
New York
Barbora
Apt. 9 H
CO
1601 Blake St.
CURE_DLQ
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Rev. 5/01/2010
(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 revision 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 the user’s legal, business or tax advisor(s).