APPLICATION FOR CERTIFICATE OF AUTHORITY FOR-PROFIT CORPORATION (ss-4431) Tre Hargett, Secretary of State State of Tennessee 312 Rosa L. Parks AVE, 6th Fl. Nashville, TN 37243-1102 (615) 741-2286 Page 1 of 2 Business Services Division For Office Use Only Filing Fee: $600.00 To the Secretary of the State of Tennessee: Pursuant to the provisions of Section T.C.A. §48-25-103 of the Tennessee Business Corporation Act, the undersigned corporation hereby applies for a certificate of authority to transact business in the State of Tennessee, and for that purpose sets forth: 1. The name of the corporation is: If different, the name under which the certificate of authority is to be obtained is: NOTE: The Secretary of State of the State of Tennessee may not issue a certificate of authority to a foreign corporation for-profit if its name does not comply with the requirements of Section T.C.A. §48-14-101 of the Tennessee Business Corporation Act. If obtaining a certificate of authority under a different corporate name, an application for registration of an assumed corporate name must be filed pursuant to Section T.C.A. §48-14-101(d) with an additional $20.00 fee. 2. The state or country under whose law it is incorporated is: and the date of its incorporation is: Month / Day / Year Month and the period of duration, if other than perpetual, is: / and, if prior to qualifying, the date it commenced doing business in Tennessee is: Day / Year Month / Day / Year NOTE: Additional filing fees and proof of tax clearance confirming good standing may apply if the corporation commenced doing business in Tennessee prior to the approval of this application. See T.C.A. §48-25-103(c) and T.C.A. §48-65-103(c). 3. This company has the additional designation of: 4. The name and complete address of its registered agent and office located in the state of Tennessee is: Name: Address: City: State: TN Zip Code: County: 5. Fiscal Year Close Month: 6. If the document is not to be effective upon filing by the Secretary of State, the delayed effective date and time is: (Not to exceed 90 days) Effective Date: Month / Day / Year Time: 7. The corporation is for profit. 8. The complete address of its principal executive office is: Address: City: State: Zip Code: *Note: Pursuant to T.C.A. §10-7-503 all information on this form is public record. SS-4431 (Rev. 1/13) Submitter Information: Name: Phone #: ( ) RDA 1678 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR CERTIFICATE OF AUTHORITY FOR-PROFIT CORPORATION (ss-4431) Tre Hargett, Secretary of State State of Tennessee 312 Rosa L. Parks AVE, 6th Fl. Nashville, TN 37243-1102 (615) 741-2286 Page 2 of 2 Business Services Division For Office Use Only Filing Fee: $600.00 The name of the corporation is: 9. The complete mailing address of the entity (if different from the principal office) is: Address: City: State: Zip Code: 10. List the name and complete address of each of its current officers: Title Name Business Address City, State, Zip 11. List the name and complete address of each of its current board of directors: Name Business Address City, State, Zip 12. Professional Corporation: Licensed Profession: (required if the additional designation of "Professional Corporation" is entered in section 3.) I certify that this is a Professional Corporation. *Note: Pursuant to T.C.A. §10-7-503 all information on this form is public record. Signature Date Signature Signer's Capacity Name (printed or typed) SS-4431 (Rev. 01/13) RDA 1678 American LegalNet, Inc. www.FormsWorkFlow.com