STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION UNIFORM CONSENT TO SERVICE OF PROCESS KNOW ALL MEN BY THESE PRESENTS: (a corporation organized by the laws of the That the undersigned State of ) (a partnership) (an individual) (other ), for the purposes of complying with the laws of the State of Florida relating to either the registration or sale of securities, as required by Chapter 517, Florida Statutes, hereby irrevocably appoints the Office of Financial Regulation and its successors, its attorney in the State of Florida upon whom may be served any notice, process or pleading in any action or proceeding against it arising out of or in connection with the sale of securities or out of violation of the aforesaid laws of said State; and the undersigned does hereby consent that any such action or proceeding against it may be commenced in any court of competent jurisdiction and proper venue within said State by service of process upon said officer with the same effect as if the undersigned was organized or created under the laws of said State and has lawfully been served with process in said State. It is requested that a copy of any notice, process or pleading served hereunder be mailed to: _____________________________ (Name and Address) Dated: ___ (Seal) By: Title: By: ______________________ Title: _____________________ Form OFR-S-5-91, Uniform Consent to Service of Process, Effective 11/22/10, Incorporated by Reference in Rules 69W-301.002, 700.001(1)(c), F.A.C. 1 American LegalNet, Inc. www.FormsWorkFlow.com CORPORATE ACKNOWLEDGEMENT STATE OF COUNTY OF ) ) ss. ) ________________________________ FIRM NAME On the day of , , before me , the undersigned, personally appeared and , known personally to me to be the (Title) and (Title), respectively, of the above named corporation, and that they, as such officers, being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the corporation by themselves as such officers. IN WITNESS WHEREOF I have hereunto set my hand and official seal. (Notarial Seal) __________________________ Notary Public My Commission expires: __________________________ INDIVIDUAL OR PARTNERSHIP ACKNOWLEDGEMENT STATE OF COUNTY OF ) ) ss. ) day of , , before me, On this the undersigned, personally appeared to me personally known to me to be the same person(s) whose name(s) is (are) signed to the foregoing instrument, and acknowledge the execution thereof for the uses and purposes therein set forth. IN WITNESS WHEREOF I have hereunto set my hand and official seal. (Notarial Seal) __________________________ Notary Public My Commission expires: __________________________ Form OFR-S-5-91, Uniform Consent to Service of Process, Effective 11/22/10, Incorporated by Reference in Rules 69W-301.002, 700.001(1)(c), F.A.C. 2 American LegalNet, Inc. www.FormsWorkFlow.com