Form 50031(a) REQUEST FOR INCLUSION IN THE UNITED STATES BANKRUPTCY COURT FOR THE SOUTHERN DISTRICT OF OHIOS OFFICIAL REGISTER OF MAILING ADDRESSES FOR FEDERAL AND STATE GOVERNMENTAL UNITS Pursuant to Federal Rule of Bankruptcy Procedure 5003(e) and Local Rule 50031, a federal or state governmental unit may file with the Court a statement designating its mailing address to be included in an official register of such addresses maintained by the Court. Please complete the following form and fax a signed copy to 9372252954, or you may mail it to Michael D. Webb, Clerk; United States Bankruptcy Court; 120 We Third Street; Dayton, OH 454021819. st Official Name of Governmental Entity: Address: If you are submitting more than one address to be used in the Southern D istrict of Ohio, please complete a separate copy of this form for each address submitted and include in this space a brief statement (2530words) of when it is appropriate to use the above address: Telephone Number (Required): Fax Number: Email Address: Website: Date Submitted: _________________ _________________________ _________________________ Signature Title 117 American LegalNet, Inc. www.USCourtForms.com