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: 860-509-6002 WEBSITE: www.concord-sots.ct.gov FAX: 860-509-6057 REQUEST FOR CERTIFICATES / LEGAL EXISTENCE USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY. FILING PARTY (Confirmation / Certificates) Will Be Sent To This Address): NAME: ADDRESS: CITY: STATE: ZIP: TELEPHONE: FINANCIAL UNIT USE ONLY AMT. REC222D $ CA CR TRANS. ID: BATCH DATE: CUSTOMER ID #: (if any) BUSINESS NAME (Enter Name Exactly As It Appears On Our Records) OR BUSINESS I.D.: BE CERTAIN YOU CHECK THE CORRECT BOX ROUTINE (Completed within 3-5 business days) EXPEDITED (Completed within 24 business hours) 1. CORPORATIONS EXPRESS CERTIFICATE OF LEGAL EXISTENCE SHORT FORM CERTIFICATE (REFLECTS ALL NAME CHANGES) LONG FORM CERTIFICATE (DOMESTIC ONLY) $50.00 $80.00 $120.00 $100.00 $130.00 {Cannot be expedited} 2. LIMITED LIABILITY COMPANIES: EXPRESS CERTIFICATE SHORT FORM CERTIFICATE (REFLECTS ALL NAME CHANGES) LONG FORM CERTIFICATE (DOMESTIC ONLY) $50.00 $50.00 $100.00 $100.00 $100.00 {Cannot be expedited} 3. LIMITED PARTNERSHIPS: CERTIFICATE OF LEGAL EXISTENCE $50.00 $100.00 4. LIMITED LIABILITY PARTNERSHIPS: EXPRESS CERTIFICATE SHORT FORM CERTIFICATE LONG FORM CERTIFICATE (DOMESTIC ONLY) $40.00 $80.00 $120.00 $90.00 $130.00 {Cannot be expedited} 5. STATUTORY TRUSTS: EXPRESS CERTIFICATE SHORT FORM CERTIFICATE $40.00 $80.00 $90.00 $130.00 6. SPECIAL CERTIFICATES: CERTIFICATE EVIDENCING (Specify type) NO RECORD $50.00 $50.00 $100.00 {Cannot be expedited} PAYMENT METHODS: Make checks payable to 223Secretary of the State224. Payment by an existing Customer ID: To fax this request you must complete the following Credit Card Payment Authorization to 860-509-6057. AMOUNT AUTHORIZED: $ CREDIT CARD BILLING INFORMATION (Failure to provide ALL Required credit card information will result in delay of processing): NAME: ADDRESS: CITY: STATE: ZIP: CARD NO.: EXPIRATION DATE: SECURITY CODE: SIGNATURE: X PAGE 1 OF 1 Revised 12/2017 FORM CXC-1-1.0 American LegalNet, Inc. www.FormsWorkFlow.com