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 COPIES USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY. FILING PARTY (C onfirmation / Cop(ies) Will Be Sent To This Address ) : NAME: ADDRESS: ZIP: CITY: TELEPHONE : STATE: FINANCIAL UNIT USE ONLY AMT. CA CR TRANS. ID: BATCH DATE: CUSTOMER ID #: (if any) BUSINESS NAME ( Enter Name Exactly As It Appears On Our Records ) : OR BUSINESS ID # : FEES ( complete d within 3 - 5 business days ) : Certified Copy - $55.00 each Plain Copy - $40.00 each Copies Will Be Mailed FEES ( completed within 24 business hours ) : Expedited Certified Copy - $105.00 each Expedited Plain Copy - $90.00 each Copies Will Be Mailed TYPE OF DOCUMENT (e.g. Certificate of Incorporation) FILING NUMBER or DATE OF FILING TYPE OF COPY / NUMBER OF COPIES 1 : Certified Copy x 55.00= $ Plain Copy x 40.00= $ 2 : Certified Copy x 55.00= $ Plain Copy x 40.00= $ 3 : Certified Copy x 55.00= $ Plain Copy x 40.00= $ FOR ADDITIONAL REQUESTS, INCLUDE 8 275 X 11 SHEETS OR SCREEN PRINT FROM WEBSITE. Total $ (OPTIONAL ) Expedited Service Total Number of Copies Requested x 50.00 = $ Grand Total $ PAYMENT METHODS (Choose One) : Payment by an existing Customer ID: To fax this request you must complete the following Cr edit Card Payment Authorization to 860 - 509 - 6057. AMOUNT AUTHORIZED: $ CREDIT CARD B ILLING 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 FORM CXC-1-1.0 Rev. 12/2017 American LegalNet, Inc. www.FormsWorkFlow.com