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 FAX: 860-509-6057 WEBSITE: www.concord-sots.ct.gov INFORMATION REQUEST 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): CUSTOMER ID: NAME: ADDRESS: MAKE CHECKS PAYABLE TO "SECRETARY OF THE STATE" CITY: STATE: EMAIL: 1. DEBTOR'S EXACT FULL LEGAL NAME IF INDIVIDUAL: SURNAME OR FIRST PERSONAL NAME ORGANIZATION ORGANIZATION NAME 2. INFORMATION OPTIONS 2A 2B REQUEST FOR INFORMATION ($50 FEE) SPECIFIC COPIES ONLY FILING NUMBER CERTIFIED ($55.00 FEE) PLAIN ($40.00 FEE) MIDDLE SUFFIX ZIP: FILING NUMBER REQUIRED INFORMATION FOR CREDIT CARD TRANSACTIONS, VISA, MASTERCARD OR AMEX. NAME ON CREDIT CARD: CREDIT CARD #: EXPIRATION DATE (MONTH/YEAR): SECURITY CODE: ZIP CODE (MUST MATCH THE CREDIT CARD BILLING ADDRESS): SIGNATURE: PAGE 1 OF 1 American LegalNet, Inc. www.FormsWorkFlow.com FORM URI-1-1.1 Rev. 6/2014 CONNECTICUT INFORMATION REQUEST FORM INSTRUCTIONS Please type or print this form. Be sure it is completely legible. Read all Instructions. Follow Instructions completely. Do not insert anything in the open space in the upper portion of this form; It is reserved for filling office use. 1. Debtor name: Enter only one Debtor name in item 1, an organization's name (1a) or an individual's name (1b). Enter Debtor's exact full legal name. Do not abbreviate. 1a. Organization Debtor. "Organization" means an entity having a legal identity separate from its owner. 1b. Individual Debtor. " Individual" means a natural person. For both organization and individual Debtors; Do not use Debtor's trade name, DBA, AKA, FKA, Division name etc. in place or combined with Debtor's legal name. 2. 2a. Check box in item 2a; if you are requesting a search of all active records, including lapsed filings. 2b. Complete item 2b if you are ordering copies of specific records by record number. 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:860-509-6002 WEBSITE: www.concord-sots.ct.gov INSTRUCTIONS DO NOT SCAN THIS PAGE American LegalNet, Inc. www.FormsWorkFlow.com FORM URI-1-1.1 Rev. 6/2014