11 F0100 Page 1 of 2 OFFICE OF THE SECRETARY OF STATE P O BOX 1020, JACKSON, MS 39215-1020 (601)359-1633 Mississippi LLC Certificate of Formation The undersigned hereby executes the following document and sets forth: (fields marked with an asterisks are required) 1. Name of the Limited Liability Company: (The name must include the words "Limited Liability Company" or the abbreviation "LLC" or "L.L.C.") * _______________________________________________________________________________________________ 2. The future effective date is (Complete if Applicable) __________________ Business Email Address:_______________________________ 3. Federal Tax ID if available (Do not put Social Security Number in the box) _______________________________________________________________________________________________ 4. Name and Street Address of the Registered Agent and Registered Office is (must be in Mississippi) *Name _____________________________________________________________________________________ *Physical Address _____________________________________________________________________________________ P.O. Box ______________________________________________________________________________________ *City ______________________________________ * State_______ * Zip5 ­ Zip4 ______________________ 5. If the Limited Liability Company is to have a specific date of dissolution, the latest date upon which the Limited Liability Company is to dissolve is _______________________________________________________________________________________________ 6. Other matters the managers or members elect to include: (Attach additional pages if necessary) _______________________________________________________________________________________________ _______________________________________________________________________________________________ Rev. 06/2012 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com F0100 Page 2 of 2 OFFICE OF THE SECRETARY OF STATE P O BOX 1020, JACKSON, MS 39215-1020 (601)359-1633 Certificate of Formation 7. Signatures: This certificate must be signed by at least one member, manager, or organizer. The name, title, and address of each signer should be included in the spaces indicated. This page may be duplicated for additional signatures. * Printed Name _____________________________________________ * Title ____________________________________ * By: Signature (please keep writing within blocks) Street and Mailing Address * Physical Address _________________________________________________________________________________________ P. O. Box ________________________________________________________________________________________ * City _____________________________________________ State ________ Zip5 ­ Zip4 __________________ Printed Name ________________________________________________Title ___________________________________ By: Signature (please keep writing within blocks) Street and Mailing Address _______________________________________________________________________________________ Physical Address _______________________________________________________________________________________ P. O. Box _______________________________________________________________________________________ City _________________________________________ State___________ Zip5 ­ Zip4 __________________ Rev. 06/2012 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com