American LegalNet, Inc. www.FormsWorkFlow.com 2013 ANNUAL REPORT FOR NONPROFIT CORPORATION Report Due August 1st File Online Today at www.sos.arkansas.gov 1 . N a me of the Nonprofit Corporation : 2. State or foreign country under whose laws the corporation was incorporated: 3. Name of Registered Agent for Service of P rocess: Address for Registered Agent, MUST be a physical address in the State of Arkansas: City: State: Zip: E - mail (optional): Phone (optional): 4 . Address for Corporation222s Principal O ffice: City: State: Zip: E - mail (optional): Phone (optional): 5. Names of Principal Officers: Address es of Principal Officers: 6.Names of Board of Directors (minimum of 3 persons): Addresses of Board of Directors: NOTE : Include any additional officers or directors on page 2, if needed. 7. Annual Report Contact Name and Address (if different than above): Address: City: State : Zip: 8. Is this entity registered with the IRS as an exempt organization? (optional) If yes, what type of exemption status is held? (optional) I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days. Executed this day of , 20 . Signature and Title of Authorized Director or Officer Printed Name of Authorized Director or Officer Arkansas Secretary of State Business & Commercial Services, 1401 W. Capitol, Suite 250, Little Roc k, AR State Capitol 225 Little Rock, AR 72201 - 1094 501 - 682 - 3409 225 www.sos.arkansas.gov No Fee Rev. American LegalNet, Inc. www.FormsWorkFlow.com Please list any additional Principal Officers or Board of Directors below: 5. Names of Principal Officers: Address es of Principal Officers: 6. Names of Board of Directors: Address es of Board of Directors: Arkansas Secretary of State Business & Commercial Services, 1401 W. Capitol, Suite 250, Little Rock, AR State Capitol 225 Little Rock, AR 72201 - 1094 501 - 682 - 3409 225 www.sos.arkansas.gov No Fee Rev.