Expedite this Form: Prescribed by: The Ohio Secretary of State Central Ohio: (614) 466-3910 Toll Free: 1-877-SOS-FILE (1-877-767-3453) (Select One) Mail Form to one of the Following: Yes PO Box 1390 Columbus, OH 43216 *** Requires an additional fee of $100 *** www.sos.state.oh.us e-mail: busserv@sos.state.oh.us No PO Box 788 Columbus, OH 43216 CONTINUED EXISTENCE OF NON-PROFIT CORPORATION (For Nonprofit Domestic or Foreign) Filing Fee $25.00 THE UNDERSIGNED DESIRING TO FILE A: (CHECK ONLY ONE (1) BOX) Statement of Continued Existence (163-CCE) (1) (2) Verification of Foreign Nonprofit (173-FCE) The corporation is still actively engaged in exercising its corporate privileges in Ohio DO HEREBY STATE THE FOLLOWING: Complete ALL of the general information in this section for the box checked above. Name of Entity Charter or License No. of Entity Complete the information in this section if box (1) is checked. Principal Location (City) (County) Date of Incorporation Complete the information in this section if box (2) is checked. Date Qualified in Ohio (Date) Incorporated in the State of Principal Location NOT in Ohio (Street) NOTE: P.O. Box Addresses are NOT acceptable. (City) (County) (State) (Zip Code) Principal Location in Ohio (Street) NOTE: P.O. Box Addresses are NOT acceptable. Ohio (County) (City) 522 Page 1 of 2 (State) American LegalNet, Inc. www.FormsWorkflow.com (Zip Code) Last Revised: May 2002 Complete the information in this section if box (2) is checked. Has your principal location or Business Address Changed Since Last Filing? Yes No If yes, an amendment (form no. 565) must be filed with an additional fee of $50.00 Name and Address of Current Agent (if applicable) (Name) (Street) NOTE: P.O. Box Addresses are NOT acceptable. Ohio (City) (County) (State) (Zip Code) Complete the information in this section if box (1) is checked. Name and Address of Current Agent (Name) (Agent must sign Acceptance of Appointment if there is a different (Street) NOTE: P.O. Box Addresses are NOT acceptable. agent on record) Ohio (County) (City) (State) (Zip Code) ACCEPTANCE OF APPOINTMENT The Undersigned ,named herein as the Statutory agent for, accepts the appointment of statutory agent for said entity. , hereby acknowledges and Signature: (Statutory Agent) REQUIRED Must be authenticated (signed) by an authorized representative (See Instructions) 522 Authorized Representative Page 2 of 2 Date American LegalNet, Inc. www.FormsWorkflow.com Last Revised: May 2002 Instructions for Continued Existence of a Non-Profit Corporation Every nonprofit foreign or domestic corporation, incorporated or registered under corporation laws of this state, or previous laws, or under special provisions of the ORC, or created before September 1, 1851, which corporation can be determined to have an expressed or implied election to be governed by the laws passed since that date, and whose articles or other documents are filed with the secretary of state, shall file with the secretary of state a verified statement of continued existence, signed by a director, officer, or three members in good standing, setting forth the corporate name, the place where the principal office of the corporation is located, the date of incorporation, the fact that the corporation is still actively engaged in exercising its corporate privileges, and the name and address of its agent appointed pursuant to the ORC. Each corporation required to file a statement of continued existence shall file it with the secretary of state within each five years after the date of incorporation or of the last corporate filing. The secretary of state shall give notice in writing and provide a form for compliance with this section to each corporation required by this section to file the statement of continued existence, such notice and form to be mailed to the last known address of the corporation as it appears on the records of the secretary of state or which the secretary of state may ascertain upon a reasonable search. In the event any nonprofit corporation required by this section to file a statement of continued existence fails to file the statement required every fifth year, then the secretary of state shall cancel the articles of such corporation, make a notation of the cancellation on the records, and mail to the corporation a certificate of the action so taken. American LegalNet, Inc. www.FormsWorkflow.com