Last Revised: 06/2019Page 1 of 4Form 522 Toll Free: 877.767.3453 | Central Ohio: 614.466.3910 OhioSoS.gov | business@OhioSoS.gov File online or for more information: OhioBusinessCentral.gov Filing Form Cover LetterPlease return the approval certificate to: Address: City: ZIP Code: Phone Number: E-mail Address: Check here if you would like to receive important notices via e-mail from the Ohio Secretary of State's office regarding Business Services. Check here if you would like to be signed up for our Filing Notification System for the business entity being created or updated by filing this form. This is a free service provided to notify you via e-mail when any document is filed on your business record. Please make checks or money orders payable to: "Ohio Secretary of State" Type of Service Being Requested: (PLEASE CHECK ONE BOX BELOW) Regular Service: Only the filing fee listed on page one of the form is required and the filing will be processed in approximately 3-7 business days. The processing time may vary based on the volume of filings received by our office. Expedite Service 1: By including an Expedite fee of $100.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 2 business days after it is received by our office. Expedite Service 2: By including an Expedite fee of $200.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 1 business day after it is received by our office. This service is only available to walk-in customers who hand deliver the document to the Client Service Center. Expedite Service 3: By including an Expedite fee of $300.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 4 hours after it is received by our office, if received by 1:00 p.m. This service is only available to walk-in customers who hand deliver the document to the Client Service Center. Preclearance Filing: A filing form, to be submitted at a later date for processing, may be submitted to be examined for the purpose of advising as to the acceptability of the proposed filing for a fee of $50.00. The Preclearance will be complete within 1-2 business days. Name (Individual or Business Name): To the Attention of (if necessary): State American LegalNet, Inc. www.FormsWorkFlow.com Last Revised: 06/2019Page 2 of 4Form 522Toll Free: 877.767.3453 Central Ohio: 614.466.3910 OhioSoS.gov business@OhioSoS.gov File online or for more information: OhioBusinessCentral.gov Mail this form to one of the following: Regular Filing (non expedite) P.O. Box 788 Columbus, OH 43216 Expedite Filing (Two business day processing time. Requires an additional $100.00) P.O. Box 1390 Columbus, OH 43216 CHECK ONLY ONE (1) BoxStatement of Continued Existence Filing Fee: $25 Form Must Be Typed (1) Statement of Continued Existence (163-CCE) (Domestic Nonprofit Corporation) (2) Verification of Foreign Nonprofit (173-FCE) (Foreign Nonprofit Corporation) Charter or License Number Name of Corporation Location of Principal Office Date of Incorporation Complete the information in this section if box (1) is checked City County Date Date of Qualification in Ohio Jurisdiction of Formation Location of Office NOT in Ohio Location of Office IN Ohio Complete the information in this section if box (2) is checked Date Jurisdiction Mailing Address City Zip Code Zip Code State City Mailing Address State By submitting this form the corporation is verifying with the secretary of state's office that it is still actively engaged in exercising its corporate privilegesForm 522 Prescribed by: For screen readers, follow instructions located at this path. American LegalNet, Inc. www.FormsWorkFlow.com Last Revised: 06/2019Page 3 of 4Form 522 Current Statutory Agent's Name and Address All Corporations must complete this section Zip Code City Mailing Address Name of Agent State Print Name By (if applicable) Signature Print Name By (if applicable) Signature Print Name By (if applicable) SignatureBy signing and submitting this form to the Ohio Secretary of State, the undersigned hereby certifies that he or she has the requisite authority to execute this document.Required The statement must be signed by a director, officer, or three members in good standing. If authorized representative is an individual, then they must sign in the "signature" box and print their name in the "Print Name" box. If authorized representative is a business entity, not an individual, then please print the business name in the "signature" box, an authorized representative of the business entity must sign in the "By" box and print their name in the "Print Name" box. American LegalNet, Inc. www.FormsWorkFlow.com Last Revised: 06/2019Page 4 of 4Form 522 Instructions for Statement of Continued Existence This form should be used by a nonprofit corporation (domestic or foreign) to verify its continued existence in Ohio. This form must be submitted every 5 years if no other filing has been submitted.Please check box (1) or box (2) to state whether the nonprofit corporation is a domestic or foreign corporation. By submitting this form, the corporation agrees to the statement at the top of the form which states the corporation is still actively engaged in exercising its corporation privileges. Corporation Information Pursuant to Ohio Revised Code 2472471702.59 and 1703.27, please provide the name of the corporation and the charter or license number assigned to the corporation in Ohio. Domestic (Ohio) Corporation Information If the corporation submitting the form is a domestic (Ohio) corporation, please provide the location of the principal office, specifically the city and county where the principal office is located. Also, please provide the date of incorporation. Foreign (Non-Ohio) Corporation Information If the corporation submitting the form is a foreign (Non-Ohio) corporation, please provide: (1) the date of qualification in Ohio; (2) the jurisdiction of formation; (3) the location of the principal office in Ohio; and (4) the location of the principal office outside of Ohio. Statutory Agent Please provide the name and address of the current statutory agent. This information may be verified on our website at www.OhioSecretaryofState.gov If the current statutory agent's name or address is incorrect, then please submit a Statutory Agent Update form (Form 521), to correct the corporate record. Note: this form may not be used to appoint a new statutory agent. Signature After completing all information on the filing form, please make sure that page 2 is signed by a director, officer or three members in good standing. **Note: Our office cannot file or record a document which contains a social security number or tax identification number. Please do not enter a social security number or tax identification number, in any format, on this form. American LegalNet, Inc. www.FormsWorkFlow.com