Phone: (503) 986-2200 Fax: (503) 378-4381 Assumed Business Name—New Registration Secretary of State Corporation Division 255 Capitol St. NE, Suite 151 Salem, OR 97310-1327 FilingInOregon.com REGISTRY NUMBER: For office use only In accordance with Oregon Revised Statute 192.410-192.490, all information on this form is publicly available, including addresses. 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. 1) ASSUMED BUSINESS NAME (To be registered) Registration or filing of a name does not grant exclusive rights or interests in that name. A name may be available for registration; however, someone else may hold a prior right to that name, or the name may be too similar to another, and may result in a case of legal action brought against the registrant for dilution or unfair competition of someone else's business. 2) DESCRIPTION OF BUSINESS (Primary business activity) 4) WHO IS AUTHORIZED TO REPRESENT THE OWNERS (AUTHORIZED REPRESENTATIVE) (One name only) 3) PRINCIPAL PLACE OF BUSINESS (Address, city, state, zip) 5) MAILING ADDRESS OF AUTHORIZED REPRESENTATIVE 6) NAMES OF OWNERS (REGISTRANTS) AND PUBLICLY AVAILABLE ADDRESSES (List name and street address of each person or entity who will conduct or transact business under the assumed business name.) (Attach a separate sheet if necessary.) NAME STREET ADDRESS 7) COUNTIES CITY/STATE/ZIP Harney Lake Morrow Union Curry Hood River Lane Multnomah Wallowa Clackamas Deschutes Jackson Lincoln Polk Wasco Clatsop Douglas Jefferson Linn Sherman Washington Columbia Gilliam Josephine Malheur Tillamook Wheeler Coos (Statewide) Crook Benton ALL COUNTIES Baker Grant Klamath Marion Umatilla Yamhill 8) EXECUTION/SIGNATURE(S) (All owners/registrants must sign.) By my signature, I declare as an authorized authority, that this filing has been examined by me and is, to the best of my knowledge and belief, true, correct, and complete. Making false statements in this document is against the law and may be penalized by fines, imprisonment or both. Signature Printed Name FEES Required Processing Fee $50 Confirmation Copy (Optional) $5 Processing Fees are nonrefundable. Please make check payable to “Corporation Division.” NOTE: Fees may be paid with VISA or MasterCard. The card number and expiration date should be submitted on a separate sheet for your protection. 9) CONTACT NAME 101 (Rev. 8/07) (To resolve questions with this filing.) DAYTIME PHONE NUMBER (Include area code.) American LegalNet, Inc. www.FormsWorkflow.com