PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Insignia (54 Pa.C.S.) Application for Registration (§ 1311) Application for Amendment (§ 1312) Document will be returned to the name and address you enter to the left. Name Address City State Zip Code Fee: $50 In compliance with the requirements of the applicable provisions (relating to registration/amendment of insignia), the undersigned organization desiring the register/amend its insignia, hereby states that: 1. The name of the applicant is (if a corporation, also give jurisdiction of incorporation): 2. The residence, location or place of business of the applicant is: Number and street City State Zip County Application for Amendment: complete paragraph 3 3. The last preceding filing with respect to this insignia was made in the Department on: at . Roll and Film , Date 4. The insignia to be registered is (a facsimile of the insignia to be registered accompanies this application as Exhibit A and is incorporated herein by reference): American LegalNet, Inc. www.FormsWorkFlow.com DSCB:54-1311/1312– 2 5. The principles and activities of the applicant organization are not repugnant to the Constitution and laws of the United States or of this Commonwealth. 6. Applicant is the owner of the name or design constituting the insignia and no other person has the right to use such insignia in this Commonwealth, either in the identical form thereof or in a form which is similar to, imitating or so nearly resembling as to be calculated to deceive. Application for Amendment: complete paragraphs 7 and 8 7. Check one of the following: The foregoing statements revise any information set forth in the preceding filing which has become inaccurate and restate in full such information as so revised. The amendment adopted to revise any information set forth in the preceding filing which has become inaccurate and to restate in full such information as so revised is as follows: 8. The amendment adopted to revise any information set forth in the preceding filing which as become inaccurate and to restate in full such information as so revised is set forth in full in Exhibit B attached hereto and made a part hereof. IN TESTIMONY WHEREOF, the undersigned organization has caused this Application to be executed this day of , . Name of Applicant Organization Signature Title American LegalNet, Inc. www.FormsWorkFlow.com Department of State Bureau of Corporations and Charitable Organizations P.O. Box 8722 Harrisburg, PA 17105-8722 (717) 787-1057 web site: www.dos.state.pa.us/corps Instructions for Completion of Form: A. Typewritten is preferred. If not, the form shall be completed in black or blue-black ink in order to permit reproduction. The filing fee for this form is $50 made payable to the Department of State. B. An application may be filed by an organization described in and complying with 54 Pa.C.S. § 1301 (relating to definitions. C. The name of a commercial registered office provider may not be used in Paragraph 2 in lieu of an address. D. A name, badge, motto, button, decoration, charm, emblem, rosette, label or other insignia may be registered on this form. The term "label" means a label, symbol, mark or private stamp, including a label adopted by labor unions for the purpose of designating the product of their particular labor or workmanship. E. This registration is effective until January 1, 2011 and will continue in effect for additional terms of ten years each if form DSCB:54-1314 (Decennial Report) is timely filed in the year 2010 and each year thereafter divisible by ten. F. This form and all accompanying documents shall be mailed to the address stated above. American LegalNet, Inc. www.FormsWorkFlow.com