Registration Or Renewal Of Entity Name Foreign Business Entity {REG}

(517) COMMONWEALTH OF KENTUCKY ALISON LUNDERGAN GRIMES, SECRETARY OF STATE Division of Business Filings Business Filings PO Box 718, Frankfort, KY 40602 (502) 564-3490 www.sos.ky.gov NOTICE: This registration only reserves a name for future use. It does not authorize the entity to do business in Kentucky. To do that, you must submit an Application for Certificate of Authority. Pursuant to the provisions of KRS 14A and KRS Chapter 271B, 273, 274, 275, 362 or 386, the undersigned applies for registration or renewal and, for that purpose, submits the following statements: 1. The entity is a : profit corporation (KRS 271B). nonprofit corporation (KRS 273). professional service corporation (KRS 274). business trust (KRS 386). limited liability company (KRS 275). limited partnership (KRS 362). professional limited liability company (KRS 275). Statutory trust limited cooperative association non-profit limited liability company cooperative association limited liability partnership (LLP) 2. The activity request is: Registration Renewal 3. The name of the entity is . 4. The state or country of organization is . 5. The date of organization is . 6. The mailing address of the entity is Street Address or Post Office Box Numbers City State Zip Code 7. The nature of the business of the entity is (Please print brief description) 8. This application will be effective upon filing, unless a delayed effective date and/or time is provided. The effective date or the delayed effective date cannot be prior to the date the application is filed. The date and/or time is. (Delayed effective date /or time) We/I declare under penalty of perjury under the laws of Kentucky that the forgoing is true and correct. Signature of Authorized Agent Printed Name Title Date Registration or Renewal of Entity Name REG (Foreign Business Entity ) American LegalNet, Inc. www.FormsWorkFlow.com (517) FILING INSTRUCTIONS REGISTRATION OR RENEWAL OF ENTITY NAME NOTICE: This registration only reserves a name for future use. It does not authorize the entity to do business in Kentucky. To do that, you must submit an Application for Certificate of Authority. TYPE OF FORMATION The entity must indicate if it is a corporation (KRS 271B), a nonprofit corporation (KRS 273), a professional service corporation (KRS 274), a business trust (KRS 386), a limited liability company (KRS 275) or a limited partnership (KRS 362) by checking the appropriate box. REGISTRATION OR RENEWAL If the entity is applying for renewal of registration of company name, check appropriate block. Please note: A registered name is effective when filed with the Secretary of State and expires on December 31st of the same year. A registered name may be renewed for successive years between October 1st and December 31st of the preceding year. When the renewal is effective, it renews the entity name registration for the following calendar year. DATE OF FORMATION The date of formation is the date the entity was organized in the state or country of its organization. PRINCIPAL OFFICE ADDRESS The principal office is the office (in or out of this state) so designated in writing with the Office of the Secretary of State where the principal designated office of the business entity is located. This address is where all correspondence from the Office of the Secretary of State (See Document Delivery) will be mailed. NATURE OF BUSINESS The entity must give a brief description of the nature of the business in which it is engaged. DELAYED EFFECTIVE DATE AND TIME The document will be effective on the date and time of filing, unless a delayed effective date and/or time is specified. The effective date or the delayed effective date cannot be prior to the date the application is filed. A delayed effective date may not be later than the 90th day after the date of filing. WHO MAY SIGN The document may be signed by the chairman of the board, president, officer, manager, member general partner, trustee or authorized representative. NUMBER OF COPIES If filing via mail or in person, one exact or conformed copy of the documents with the filing fee must be submitted to the address below. To anization search tool. DOCUMENT DELIVERY A file stamped postcard will be sent to the principal office address. If the applicant wishes for the document to be sent to an alternate address other than the principal office, a request must be submitted in writing affirming that request. Alternate address requests must be submitted with each document filed with the Office of the Secretary of State. FILING FEE The filing fee for this document is $36.00. Checks should be made payable to the "Kentucky State Treasurer." MAILING ADDRESS OFFICE LOCATION Alison Lundergan Grimes Room 154, Capitol Building Secretary of State 700 Capital Avenue P. O. Box 718 Frankfort, KY 40601 Frankfort, KY 40602-0718 Hours of Operation: 8:00 AM-4:30 PM ET CONTACT INFORMATION AND NAME AVAILABILITY If you have any questions, need additional forms or wish to search for name availability, please feel free to visit our website at www.sos.ky.gov or call (502) 564-3490. American LegalNet, Inc. www.FormsWorkFlow.com