E PL UN PUL UM N U LL PO URI B US SALUS Robin Carnahan, Secretary of State DIV D AN ED WE FA ID D WE S T ITE State of Missouri I SUPREM MDC X ESTO LE A CCXX Corporations Division PO Box 778 / 600 W. Main St., Rm. 322 Jefferson City, MO 65102 Application for Certificate of Authority For a Foreign For-Profit Corporation (Submit with filing fee of $155.00) 1. The corporation’s name is and it is organized and existing under the laws of 2. The name it will use in Missouri is 3. The date of its incorporation was , and the period of its duration is month/day/year 4. The address of its principal place of business is Address City/State/Zip 5. The name and physical address of its registered agent and office in the State of Missouri is Name Address City/State/Zip 6. The specific purpose(s) of its business in Missouri are: 7. The name of its officers and directors and their business addresses are as follows: Officers Name Address City/State/Zip President Vice President Secretary Treasurer Board of Directors Director Director Director Director Director (Please see next page) Name and address to return filed document: Name: Address: City, State, and Zip Code: Corp. 42 (11/2008) American LegalNet, Inc. www.FormsWorkflow.com 8. The effective date of this document is the date it is filed by the Secretary of State of Missouri, unless you indicate a future date, as follows: (Date may not be more than 90 days after the filing date in this office) 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) Must be an Officer or Chairman listed in #7 Printed Name Title Date Note: You must submit current original certificate of good standing or certificate of existence with this application. This may be obtained from your Secretary of State or other authority that issues corporate charters. Corp. 42 (03/2008) American LegalNet, Inc. www.FormsWorkflow.com