SECRETARY OF THE STATE OF CONNECTICUT MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470 DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106 PHONE: 860-509-6003 WEBSITE: www.concord-sots.ct.gov APPLICATION FOR REGISTRATION OF CORPORATE NAME FOREIGN CORPORATION USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY. FILING PARTY (CONFIRMATION WILL BE SENT TO THIS ADDRESS): FILING FEE: $60 MAKE CHECKS PAYABLE TO "SECRETARY OF STATE" NAME: ADDRESS: CITY: STATE: ZIP: THE UNDERSIGNED HEREBY APPLIES FOR REGISTRATION OF THE FOLLOWING CORPORATE NAME. 1. CORPORATE NAME: 2. STATE OR COUNTRY OF INCORPORATION: 3. DATE OF INCORPORATION: 4. THE NATURE OF BUSINESS IN WHICH THE CORPORATION IS ENGAGED: 5. ADDRESS OF THE CORPORATION: ADDRESS: CITY: STATE: ZIP: 6. EXECUTION: DATED THIS NAME OF SIGNATORY DAY OF CAPACITY/TITLE OF SIGNATORY , 20 SIGNATURE THE APPLICATION MUST BE ACCOMPANIED BY A CERTIFICATE OF EXISTENCE, PLEASE SEE INSTRUCTION SHEET FOR DETAILS. PAGE 1 OF 1 American LegalNet, Inc. www.FormsWorkFlow.com FORM CFNR-1-1.0 Rev. 5/2011 INSTRUCTIONS 1. Please return completed registration form to the Office of the Secretary of the State at the below referenced address. 2. The application must be accompanied by a Certificate of Existence issued by the official keeper of corporate records in the state or country of the corporation's formation. This Certificate may not be more than 90 days old at the time of filing. 3. A registration of corporate name expires at the end of the calendar year in which an application is filed. 4. Please type or print all information other than the signature. OFFICE OF THE SECRETARY OF THE STATE MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470 DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106 PHONE: 860-509-6003 WEBSITE: www.concord-sots.ct.gov PAGE 2 OF 2 DO NOT SCAN THIS PAGE American LegalNet, Inc. www.FormsWorkFlow.com FORM CNFR-1-1.0 Rev 5/2011