Arkansas Secre t a ry of State Charlie Daniels State Capitol • Little Rock, Arkansas 72201-1094 501-682-3409 • www.sos.arkansas.gov Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock CORPORATE FRANCHISE TAX In order for this corporation to receive its annual corporate franchise tax reporting form, please complete and file with the office of the Secretary of State at the time of incorporation or qualification. Corporate name Contact person Street address or Post Office Box number City, State, ZIP Telephone number E-mail address NOTE: This tax is due on or before May 1 of the year following incorporation or qualification in this state. 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. Authorized Officer (Type or Print) Authorized Signature of Incorporator, Officer or Agent for the Corporation FT-11 Rev. 4/06 American LegalNet, Inc. www.FormsWorkFlow.com