INSTRUCTIONS: 1. Use 8275224 x 11224 white paper for attachments. 2. Please TYPE or PRINT in INK. 3. Please visit our office on the web at www.sos.IN.gov 4. Make check or money order payable to the Secretary of State. 5. Submit original completed paperwork and payment to: 302 West Washington Street, Room E-018, Indianapolis, IN 46204. REQUIREMENTS: 1. Applicants must submit a certificate of existence issued by the proper authority within the last sixty (60) days. 2. Professional corporations must complete the professional license information below. (SOS use only) (If different from above 226 SOS use only) FOR PROFESSIONAL CORPORATIONS ONLY Please complete the following section so the Indiana Secretary of State can verify licensing information. Information for only one shareholder is required. (number and street, city, state, and ZIP code) American LegalNet, Inc. www.FormsWorkFlow.com (The name must comply with Indiana Code 23-0.5-3-1.) (select one) (select one) (optional) (month, day, year) To determine if your Registered Agent is a Commercial Registered Agent (CRA), go to INBIZ.in.gov. Provide either commercial registered agent or noncommercial registered agent information below. (Do not provide address.) (number and street) (A P.O. Box is not acceptable unless accompanied by a Rural Route number.) (OPTIONAL) American LegalNet, Inc. www.FormsWorkFlow.com