Form 500 Prescribed by the: Mail this form to: Ohio Secretary of State PO Box 1329 Columbus, OH 43216 Central Ohio: (614) 466-3910 Toll Free: (877) SOS-FILE (767-3453) www.sos.state.oh.us Busserv@sos.state.oh.us CERTIFICATION / COPY REQUEST (See Instructions for Fee Information) Submitter's Information Name Address Phone Number Request Information Entity Name Charter/License/Registration Number Pick up at Client Service Center Return by Mail CERTIFICATES COPIES Number of Certificates Requested: Number of Copies Requested: (Choose one by checking box below) Good Standing Certificate Full Force and Effect Certificate Long Form Certificate Name Change Certificate Date filed: Merger Certificate Date filed: Consolidation Certificate Date filed: No Record Certificate Dissolution Certificate Cancellation Certificate Surrender Certificate Agent Certificate Conversion Certificate Date filed: Qualification Certificate Date filed: Form 500 (Choose one by checking box below) All Entity Documents *(Defined on Page 3) Articles of Incorporation Amendment to Articles Date filed: Amended/Restated Articles Date filed: Trademark/Service Mark Fictitious Name Trade Name Limited Liability Company Limited Liability Partnership Limited Partnership Partnership Foreign License Misc. Filing Date filed: Page 1 of 3 Plain Certified Plain Plain Certified Certified Plain Certified Plain Plain Plain Plain Plain Plain Plain Plain Plain Certified Certified Certified Certified Certified Certified Certified Certified Certified Last Revised: 12/01/2008 American LegalNet, Inc. www.FormsWorkflow.com Instructions for Certification/Copy Request This form must be used to file a request for a certificate, a plain copy or a certified copy. The secretary will authenticate records by providing Certificates for specific types of filings. The secretary will also provide plain or certified copies of a requested record. Submitters Information Please provide the name of the person or business entity requesting the records. Also, provide the submitter's address and a telephone number for us to contact the submitter if we have questions regarding the request. Request Information Please provide the name of the entity and its charter/license/registration number. Also, indicate whether the submitter will pick up the documents in our Client Service Center at 180 E. Broad St Columbus, Ohio 43215 or if the documents should be mailed to the submitter's address provided on the form. If you do not select either box, our office will mail the records to the address provide Certificates Indicate the number of certificates requested and check the appropriate box indicating the type(s of certificate(s) needed. If necessary please provide the date of filing under the name of the certificate being requested. Fees: $5.00 fee for Good Standing, Full Force and Effect, No Record, Name Change, Agent of Record, Dissolution/Surrender, Qualification and Cancellation Certificates. $25.00 fee for Merger, Name Change within a Merger, Consolidation, Conversion and Long Form Certificates. Copies Indicate the number of copies being requested and if you want the copies to be plain or certified checking the appropirate box. Fees: There is no fee for plain copies. These documents may also be accessed on our website at www.sos.state.oh.us. $5.00 fee for a certified copy. If the copy request exceeds 100 pages, an additiona fee of $5.00 will be billed and sent to the submitter with the certified copies. **Note: Our office cannot file or record a document that 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. Types of Certificates/Copies Good Standing Certificate: Certificate applies to Domestic and Foreign corporations. The corporation must be active on our records and in compliance with all filing requirements. Form 500 Page 2 of 3 Last Revised: 12/01/2008 American LegalNet, Inc. www.FormsWorkflow.com Full Force and Effect Certificate: Certificate applies to Limited Liability Companies, Limited Partnerships, Limited Liability Partnerships, Trade Names, Fictitious Names, Business Trust, Real Estate Investment Trust and Trademark/Service Marks. The entity must be active on our records and in compliance with all filing requirements. Long Form Certificate: Certificate lists the entire history of an entity, with the exception of statutory agent changes and cancellations that may have occurred. Name Change Certificate: Certificate will show name changes filed with the secretary of state's office. If a name changed within a merger, this name change certificate will be appear as a merg certificate, with the name change reflected within the certificate. Please notice the fee section on page two for fee information. Merger Certificate: Certificate states the particulars of a specific merger filed with the secretary state's office. Consolidation Certificate: Certificate states the information related to a specific consolidation filed with the secretary of state. No Record Certificate: Certificate states a specific name is not on record as an active, inactive or canceled trade name/fictitious name or business entity. Dissolution Certificate: Certificate applies to domestic corporations that are dissolved on the secretary of state's records. Cancellation Certificate: Certificate states if the entity is currently canceled and by whom, such as canceled by the Department of Taxation or by the secretary of state for a failure to maintain a statutory agent. Surrender Certificate: Certificate states a foreign corporation's license was surrendered and the entity no longer is active on the secretary of state's records. Agent Certificate: Certificate states the name and address of the current agent on record with th secretary of state. Conversion Certificate: Certificate states conversion information for entities converting within the records, off the records and into the records of the secretary of state. Qualification Certificate: Certificate states the qualification information for an entity qualifying o the records of the secretary of state to become a limited liability partnership. All Entity Documents: If the request is for "All Entity Documents," we will provide the original document and changes to this document including amendments, amended or restated articles, mergers, consolidations, conversions, qualifications and dissolutions/surrenders. Documents su as statutory agent updates, trademark/service mark applications, and trade/fictitious name registrations are not included and must be ordered as miscellaneous filings if necessary. Form 500 Page 3 of 3 Last Revised: 12/01/2008 American LegalNet, Inc. www.FormsWorkflow.com