AFFIDAVIT OF FOREIGN PROFESSIONAL CORPORATIO N Comes now _____________________________________________ as __________________________________________________ (name) (office held) of the __________________________________________________, a __________________________________________________ (corporate name) (state) corporation and being duly sworn does upon his oath state: All the __________________________________________________________________________________shareholders, a (Corporate Name) majority of the directors and all the officers, except for the possibility of the secretary and treasurer, are licensed in one or more states or territories of the United States or the District of Columbia to render a professional service described in the statement of purposes of the corporation. In Affirmation thereof, the facts stated above are true and correct: (The undersigned understands that false statements made in this filing are subject to the penalties provided under Section 575.040, RSMo)_______________________________________________________________________________________________________________ Signature Printed Name Title Date ___________________________________________________ Name of Affiant Aff. (08/04)