Application For Certificate Of Authority To Transact Business

FILING FEE: $145.00 (if you have more than one page listing officers and directors please add $5.00 a page for each additional page) Revised Neb. Rev. Stat. 24421-2,205 APPLICATION FOR CERTIFICATE OF AUTHORITY TO TRANSACT BUSINESS , Secretary of State P.O. Box 94608 Lincoln, NE 68509 Attach a certificate of existence, or document of similar import, duly authenticated by the secretary of state or other official having custody of the corporate records in the state or country under whose law the corporation is incorporated. Such certificate shall not be more than sixty (60) days old. A certified copy of the articles of incorporation should not be submitted and is not acceptable in lieu of such certificate. Name of Corporation Fictitious Name of Corporation* (to be used only if actual corporate name is unavailable for use or does not comply with Nebraska law) *Must provide a resolution from the Board of Directors signed by the Secretary adopting this fictitiousname. Note: Fictitious name must contain one of the words incorporated, corporation, limited or anabbreviation thereof.Incorporated under the laws of Date of Incorporation Period of Duration Address of Principal Office Street Address City State Zip Registered Agent Registered OfficeNE Street Address and Post Office Box (if any) City Zip Effective date if other than the date filed Signature Printed Name/Title The Model Business Corporation Act requires that every filing be signed by the chairperson of the board of directors, the president, or one of the officers of the corporation. If the corporation has not yet been formed or directors have not yet been selected, the filing shall be signed by an incorporator. If the corporation is in the hands of a receiver, trustee, or other court appointed fiduciary, the filing shall be signed by that fiduciary. NOTE: To complete this filing you must provide a list of officers and directors names and street addresses. American LegalNet, Inc. www.FormsWorkFlow.com OFFICERS: DIRECTORS: Name/Title Name Street Address Street Address City State Zip City State Zip Name/Title Name Street Address Street Address City State Zip City State Zip Name/Title Name Street Address Street Address City State Zip City State Zip Name/Title Name Street Address Street Address City State Zip City State Zip Name/Title Name Street Address Street Address City State Zip City State Zip Name/Title Name Street Address Street Address City State Zip City State Zip Please Copy this page and submit additional pages if needed. American LegalNet, Inc. www.FormsWorkFlow.com