BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July, 2017) (Form BE-13) STATE OF NORTH CAROLINA DEPARTMENT OF THE SECRETARY OF STATE APPLICATION TO REGISTER AN ENTITY NAME BY A FOREIGN ENTITY Pursuant to 24755D-24 of the General Statutes of North Carolina, the undersigned foreign entity hereby applies to the Secretary of State to register the following entity name: THIS IS [ ] AN INITIAL OR [ ] A RENEWAL APPLICATION* 1. The entity name to be registered is: Entity Type: Foreign Corporation, Foreign Nonprofit Corporation, Foreign Limited Liability Company, Foreign Limited Partnership, Foreign Limited Liability Partnership. 2. The applicant entity was incorporated or formed under the laws of the state or county of on the day of , . 3. The business or activity in which the entity is engaged is: 4. This application is accompanied by a certificate of existence (or a document of similar import) duly authenticated by the secretary of state or other official having custody of entity records in the state or country of incorporation or formation. This the day of , 20. Name of Entity Signature Type or Print Name and Title Notes: 1. Filing fee is $10.00. One executed original of this application must be filed with the Secretary of State. 2. If N.C.G.S. 24755D-22 requires an addition to the corporate name, the applicant must set forth its corporate name with such addition. An initial registration is effective upon the date of filing of the initial application for registration and until the end of the calendar year in which it became effective. A renewal of registration must be filed between October 1 and December 31 in order to renew the registration for the following calendar year. This document is not considered a Certificate of Authority to transact business in North Carolina. THIS REGISTRATION DOES NOT GIVE THE BUSINESS ENTITY THE AUTHORITY TO TRANSACT BUSINESS IN NORTH CAROLINA. AN APPLICATION FOR CERTIFICATE OF AUTHORITY MUST BE FILED IF THE BUSINESS ENTITY INTENDS TO TRANSACT BUSINESS IN NORTH CAROLINA. American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July, 2017) (Form BE-13) APPLICATION TO REGISTER AN ENTITY NAME Instructions for Filing (Form BE-13) Check the appropriate blank for an initial or renewal application. Item 1 Enter the complete entity name to be registered exactly as it appears on the Certificate of Existence. Item 2 Enter the name of the state or country of formation and the date of formation. Item 3 Enter the type of business or activity in which the entity is engaged. Item 4 See form. Date and Execution: Enter the date the document was executed. In the blanks provided enter: The name of the entity registering the name. The signature of an appropriate representative of the entity. The name and title of the above-signed representative. American LegalNet, Inc. www.FormsWorkFlow.com