STATE OF OKLAHOMA NOTICE OF APPOINTMENT OF REGISTERED AGENT AND REGISTERED AGENT’S STATEMENT (68 O.S. § 360.5) OAG-TOB2 (03/2007) Page 1 of 2 Please type or print in permanent blue ink. Sign, date, and return original to: Office of the Attorney General State of Oklahoma Tobacco Enforcement Unit 313 NE 21st Street Oklahoma City, OK 73105-4894 The undersigned Non-Participating Manufacturer (“NPM”),__________________________________________ hereby appoints ________________________________________________________ as its registered agent. Said registered agent is authorized to receive service of process on behalf of the NPM. The NPM agrees to do the following: (1) provide notice to the Office of the Attorney General of the State of Oklahoma(“Attorney General”) at least 30 calendar days prior to termination of the authority of the registered agent; and (2) provide proof to the satisfaction of the Attorney General of the appointment of a new agent at least five calendar days prior to the termination of the existing agent appointment. The NPM further agrees that if the agent terminates its agency appointment, the undersigned shall provide notice to the Attorney General of the termination within five calendar days and shall include proof to the Attorney General of the appointment of a new agent. I hereby certify and declare that all of the statements and information contained in this Notice of Appointment, including but not limited to any accompanying statements or attachments herewith, are true and complete and that I am a person authorized to bind the NPM making this Notice of Appointment either under the laws of Oklahoma or of the jurisdiction where the manufacturer resides or is organized. The failure to file this form is a basis for removal of the undersigned NPM and its Brand Families from the Directory. This Notice of Appointm ent must be signed and dated in the presence of a notary public. Signature of authorized representative for NPM:_________________________________________ Authorized Representative (Print Name):_______________________________________________ Title:___________________________________________________________________________ Principle Place of Business (physical address):___________________________________________ STATE OF___________________________________) COUNTY OF_________________________________ ) COUNTRY OF _______________________________ ) On________________________________ , before me,________________________________ , personally appeared ________________________________________________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the instrument herein and acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. Signature:_______________________________________________________ My Commission expires:____________________________________________ My Commission Number:___________________________________________ American LegalNet, Inc. www.FormsWorkflow.com STATE OF OKLAHOMA NOTICE OF APPOINTMENT OF REGISTERED AGENT & REGISTERED AGENT’S STATEMENT (68 O.S. § 360.5) OAG-TOB2 (03/2007) Page 2 of 2 NAME AND ADDRESS OF OKLAHOMA STATE REGISTERED AGENT: Name:_________________________________________________________________________________________ Street Address (Required-Must be within the state of Oklahoma) :__________________________________________ _______________________________________________________________________________________________ P.O. Box (Optional) :______________________________________________________________________________ City and State:________________________________________________ Zip Code:__________________________ Telephone:_____________________________ Facsimile Number:______________________________ E-mail address:__________________________________________________________________________________ I consent to serve as the Registered Agent in the State of Oklahoma for the above-named NPM, pursuant to Section 360.5 of Title 68 of the Oklahoma Statutes. I understand it will be my responsibility to receive Service of Process on behalf of the NPM; to forward mail to the NPM; and to immediately notify the Office of the Attorney General if I resign or change the office address of the Registered Agent. This Notice of Appointment must be signed and dated in the presence of a notary public. Signature:_____________________________________________________ Date:____________________________ Print Name:_____________________________________________________________________________________ Title:___________________________________________________________________________________________ STATE OF______________________________) COUNTY OF ____________________________) COUNTRY OF ___________________________) On ,_____________________________ before me,___________________________________ , personally appeared ________________________________________________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. Signature:_______________________________________________________ My Commission expires:____________________________________________ My Commission Number:___________________________________________ American LegalNet, Inc. www.FormsWorkflow.com