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