FIS 0560 (5/04) Office of Financial and Insurance Services This form is issued under Section 25 of Act 440, PA of 1976, as amended, and Rule 21 MICHIGAN DEPARTMENT OF LABOR & ECONOMIC GROWTH OFFICE OF FINANCIAL AND INSURANCE SERVICES SECURITIES SECTION CONSENT TO SERVICE OF PROCESS KNOW ALL MEN BY THESE PRESENTS: That the undersigned, Organized under the laws of the State of For the purpose of complying with the Living Care Disclosure Act, 1976 P.A. 440, as amended, of the State of Michigan, relating to registration, exemption from registration or the sale of Life Interest or Long-Term Leases, hereby irrevocably appoints the Michigan Office of Financial and Insurance Services and the successors in such office, its attorney in the State of Michigan upon whom may be served any notice, process or pleading in any action or proceeding against it arising out of or in connection with the sale of Life Interests or Long-Term Leases, or out of violation of the aforesaid law of said State; and the undersigned does hereby consent that any such action or proceeding against it may be commenced in any court of competent jurisdiction and proper venue within said State by service of process upon said officer with the same effect as if the undersigned was organized or created under the laws of said State and had lawfully been served with process in said State. It is requested that a copy of any notice, process or pleading served hereunder be mailed to: (Name) (Address) Dated: (SEAL) By Title By Title American LegalNet, Inc. www.FormsWorkflow.com