OKLAHOMA ATTORNEY GENERAL - TOBACCO ENFORCEMENT UNIT NOTICE OF APPOINTMENT OF IMPORTER'S REGISTERED AGENT, REGISTERED AGENT'S STATEMENT, AND CONSENT TO JURISDICTION The undersigned Importer hereby appoints ____________________________________ as its registered service agent within the State of Oklahoma. Said registered agent is authorized to receive service of process on behalf of the Importer. The Importer further agrees to the following: (1) The Importer must provide notice to the Office of the Attorney General of the State of Oklahoma ("Attorney General") at least thirty (30) calendar days prior to termination of the authority of the registered agent; (2) The Importer must provide proof to the satisfaction of the Attorney General of the appointment of a new agent at least five (5) calendar days prior to the termination of the existing agent appointment. The Importer further agrees that if the agent terminates its agency appointment, the undersigned shall provide notice to the Attorney General of the termination within five (5) calendar days and shall include proof to the Attorney General of the appointment of a new agent; (3) The Secretary of State for the State of Oklahoma will act as service agent if the registered agent dies, resigns, or otherwise is unavailable to accept service on behalf of the nonparticipating manufacturer or importer; and (4) Consents to be sued in the district courts of the State of Oklahoma for purposes of state enforcing any provision of the the Prevention of Youth Access to Tobacco Act, the Master Settlement Agreement Complementary Act, and Oklahoma cigarette excise tax statutes. I hereby certify and declare that all of the statements and information contained in this Notice of Appointment and Consent to Jurisdiction, including, but not limited to any accompanying statements or attachments herewith, are true and complete and that I am a person authorized to bind the Importer making this Notice of Appointment either under the laws of Oklahoma or of the jurisdiction where the manufacturer resides or is organized. The failure to file this form is a basis for removal from the Directory and its brand families for which the Importer has agreed to Joint and Severable Liability. THIS NOTICE OF APPOINTMENT AND CONSENT TO JURISDICTION MUST BE SIGNED AND DATED IN THE PRESENCE OF A NOTARY PUBLIC. Authorized Representative for Importer: _______________________________________________ Signature: _____________________________ Print: ___________________________________ Title: _________________________________ Principle Place of Business (physical address): _________________________________________ _______________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com STATE OF ____________________ ) COUNTY OF __________________ ) ss. COUNTRY OF _________________ ) On ___________________, 20____, before me personally appeared _____________________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the instrument herein and acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. Signature: _______________________________ My Commission expires: ____________________ My Commission Number: ___________________ American LegalNet, Inc. www.FormsWorkFlow.com REGISTERED AGENT'S STATEMENT OKLAHOMA STATE REGISTERED AGENT: Registered Agent's Name: __________________________ Company: _____________________ Address: _______________________________________________________________________ (Must be within the state of Oklahoma) City: ____________________________ State: ____________________ Zip Code: __________ Telephone: ________________________ Facsimile Number: ____________________________ E-mail address: __________________________________________________________________ I consent to serve as the Registered Agent in the State of Oklahoma for the above-named Importer, pursuant to the Oklahoma Statutes. I understand it will be my responsibility to receive Service of Process on behalf of the above-named Importer; to forward mail to the Importer, and to immediately notify the Office of the Attorney General if I resign or change the office address of the Registered Agent. THIS NOTICE OF APPOINTMENT MUST BE SIGNED AND DATED IN THE PRESENCE OF A NOTARY PUBLIC. Signature: ________________________________ Print: ________________________________ Title: _____________________________________ Date: _______________________________ American LegalNet, Inc. www.FormsWorkFlow.com STATE OF ____________________ ) COUNTY OF __________________ ) ss. COUNTRY OF _________________ ) On ___________________, 20____, before me personally appeared _____________________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the instrument herein and acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. Signature: _______________________________ My Commission expires: ____________________ My Commission Number: ___________________ American LegalNet, Inc. www.FormsWorkFlow.com