NONPROFIT CERTIFICATE OF DISCLOSURE Pursuant to A.R.S. § 10-3202 (D) ________________________________________________ EXACT CORPORATE NAME A. Has any person serving either by election or appointment as officer, director, trustee, or incorporator in the corporation: 1. Been convicted of a felony involving a transaction in securities, consumer fraud or antitrust in any state or federal jurisdiction within the sevenyear period immediately preceding the execution of this Certificate? 2. Been convicted of a felony, the essential elements of which consisted of fraud, misrepresentation, theft by false pretenses, or restraint of trade or monopoly in any state or federal jurisdiction within the seven-year period immediately preceding the execution of this Certificate? 3. Been or are subject to an injunction, judgment, decree or permanent order of any state or federal court entered within the seven-year period immediately preceding the execution of this Certificate wherein such injunction, judgment, decree or permanent order: (a) Involved the violation of fraud or registration provisions of the securities laws of that jurisdiction; or (b) Involved the violation of the consumer fraud laws of that jurisdiction; or (c) Involved the violation of the antitrust or restraint of trade laws of that jurisdiction? Yes _______ No _______ B. IF YES, the following information MUST be attached: 1. 2. 3. 4. 5. Full name and prior name(s) used. Full birth name. Present home address. Prior addresses (for immediate preceding 7-year period). Date and location of birth. 6. The nature and description of each conviction or judicial action, date and location, the court and public agency involved and file or case number. C. Has any person serving as an officer, director, trustee or incorporator of the corporation, served in any such capacity in any other corporation in any jurisdiction on the bankruptcy or receivership of the other corporation? Yes _______ No _______ IF YOUR ANSWER TO THE ABOVE QUESTION IS "YES", YOU MUST ATTACH THE FOLLOWING INFORMATION FOR EACH CORPORATION: 4. Dates of corporate operation. 1. Name and address of the corporation. 5. A description of the bankruptcy or receivership, including the 2. Full name, including alias and address of each person date, court or agency and the file or case number. involved. 3. State(s) in which the corporation: (a) Was incorporated. (b) Has transacted business. Under penalties of law, the undersigned incorporators/officers declare that we have examined this Certificate, including any attachments, and to the best of our knowledge and belief it is true, correct and complete, and hereby declare as indicated above. THE SIGNATURE(S) MUST BE DATED WITHIN THIRTY (30) DAYS OF THE DELIVERY DATE. BY DATE TITLE BY TITLE BY DATE_________________ TITLE ___________________________________________________ DATE BY DATE________________ TITLE __________________________________________________ DOMESTIC CORPORATIONS: ALL INCORPORATORS MUST SIGN THE INITIAL CERTIFICATE OF DISCLOSURE. (If more than four Incorporators, please attach remaining signatures on a separate sheet of paper.) If within sixty (60) days, any person becomes an officer, director, or trustee and the person was not included in this disclosure, the corporation must file an AMENDED certificate signed by all incorporators, or if officers have been elected, by a duly authorized officer. FOREIGN CORPORATIONS: MUST BE SIGNED BY AT LEAST ONE DULY AUTHORIZED OFFICER OF THE CORPORATION. CF: 0001 - Non-Profit Rev: 09/2008 Arizona Corporation Commission Corporations Division American LegalNet, Inc. www.FormsWorkflow.com