Phone: (503) 986-2200 Fax: (503) 378-4381 Assumed Business Name – Amendment Secretary of State Corporation Division 255 Capitol St. NE, Suite 151 Salem, OR 97310-1327 FilingInOregon.com REGISTRY NUMBER: In accordance with Oregon Revised Statute 192.410-192.490, the information on this application is public record. We must release this information to all parties upon request and it will be posted on our website. For office use only Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary. To change business name use new registration, Form 101. 1) ASSUMED BUSINESS NAME: 2) DESCRIPTION OF BUSINESS 4) NAME OF AUTHORIZED REPRESENTATIVE (One name only) CONTINUING NEW 3) PRINCIPAL PLACE OF BUSINESS (Street address, city, state, zip) 5) MAILING ADDRESS OF AUTHORIZED REPRESENTATIVE 6) REGISTRANTS/OWNERS (List name and publicly available street address of each person or entity who will conduct or transact business under the assumed business name.) (All new registrants must be listed. If registrants are withdrawing, both continuing and withdrawing registrants must be listed.) NEW REGISTRANTS (Name, Street Address) CONTINUING REGISTRANTS (Name, Street Address) WITHDRAWING REGISTRANTS 7) COUNTIES Baker ALL COUNTIES (Statewide) Crook Harney Lake Morrow Union Benton Clackamas Clatsop Columbia Coos Curry Deschutes Douglas Gilliam Grant Hood River Jackson Jefferson Josephine Klamath Lane Lincoln Linn Malheur Marion Multnomah Polk Sherman Tillamook Umatilla Wallowa Wasco Washington Wheeler Yamhill 8) SIGNATURES Any change requires a signature. New registrants must sign. If any registrants are WITHDRAWING, withdrawing Registrants or Authorized Representative must sign. If there is a change of Authorized Representative, all registrants must sign. 9) CONTACT NAME (To resolve questions with this filing.) DAYTIME PHONE NUMBER (Include area code.) FEES No Processing Fee Confirmation Copy (Optional) $5. 102 (Rev. 5/07) American LegalNet, Inc. www.FormsWorkflow.com