Instructions for properly completing a Certification Memo Submitter's Information Mark the appropriate priority box. (additional Expedited Cost) Fees: Priority 1 (One hr) Priority 2 (Two hr) Priority 3 (Same Day) Priority 4 (24 hour) $1000.00 $ 500.00 Varies ­ Please contact our Office Varies ­ Please contact our Office Submitter's Information 1. 2. Completely fill out your individual or business/firm name and complete address. The attention line needs to be completed if a business or firm name is listed. The account number is only to be completed by entities that have an existing Depository account with the Division of Corporations. Please ignore this field if you do not have a Depository account. Certification Request Information Complete the name of the entity and the entity File number. If you do not have the file number, you may leave it blank. Method of Return Information All documents are returned Regular Mail or you can provide a Fed-X or UPS account number for express mail. Please mark the appropriate method of return. Credit Card Information All credit card information must be completed. If the credit card information is not the same as it is listed with the submitter's information, then please specify the correct information in the comments/filings instruction area on the bottom right hand side of the memo. You must also include your 3-4 digit security code on the back of the card. Please contact our office at 302-739-3073 with any questions or for verification of fees. Return forms and memos to: Delaware Division of Corporations 401 Federal Street - Suite 4 Dover, DE 19901 American LegalNet, Inc. www.FormsWorkFlow.com State of Delaware - Division of Corporations CERTIFICATION SHEET - Fax# 302-739-3812 Priority 1 (One Hr) Priority 2 (Two Hr) Priority 3 (Same Day) Priority 4 (24 Hour) Priority 7 (Reg. Work) DO NOT WRITE IN THIS SPACE SUBMITTER'S INFORMATION Company/Firm or Individual's Name _______________________________________ Return Address ________________________________________________________ City-State-Zip Attention: Phone Country _______________________ ___________________________________________________________ __ ________________________ Fax# ____________________________ E-mail address ________________________________________________________ Account Number _____________ CERTIFICATION REQUEST INFORMATION Name of Company/Entity File Number Type of Certificate Requested Certified Copy of All Charter Documents Certified Copy of Charter Documents, Restated Forward Certified Copy Filed on Short Form Good Standing (check if additional language req.) Incorporation Date METHOD OF RETURN Messenger/Pick up Express Mail Acct# Regular Mail Other Fax or E-mail is not available Long Form Good Standing COMMENTS/FILING INSTRUCTIONS Certificate in RE: (Type of Cert.) Apostille - Country Other Check # Total $ Enclosed CREDIT CARD INFORMATION (Visa, MasterCard, American Express or Discover Card Only) INSTRUCTIONS 1. 2. Visit corp.delaware.gov/cvrmemo.shtml for complete instructions on how to properly complete this memo. Fully shade in the required Priority Square using a dark pencil or marker, staying within the square. CC# Expiration Date Security Code / - - Delaware Division of Corporations, 401 Federal Street, Ste. 4, Dover, De 19901 American LegalNet, Inc. www.FormsWorkFlow.com