For Office Use Only Corporate Filings 312 Rosa L. Parks Ave. 6th Floor, William R. Snodgrass Tower Nashville, TN 37243 APPLICATION FOR REGISTRATION OF FOREIGN CORPORATE NAME To the Secretary of State of the State of Tennessee: Pursuant to the provisions of Section 48-14-103 of the Tennessee Business Corporation Act or Section 48-54103 of the Tennessee Nonprofit Corporation Act, the undersigned corporation hereby applies for the registration of its corporate name or assumed corporate name to and including December 31st of the current year and submits the following statement: 1. The name of the corporation is . If different, the name to be registered in the State of Tennessee is . [NOTE: The name must be distinguishable upon the records of the Secretary of S from the corporate names that tate are not available under Section 48-14-101(b) of theTennessee Business Corporation Act or Section 48-54-101(b) of the Tennessee Nonprofit Corporation Act.] 2. The state or country of incorporation is 3. The date of incorporation is 4. The nature of the business of the corporation is . [NOTE: This application must be accompanied by a certificate of existence or document of similar import (for example, a certificate of good standing) duly authenticated by the Secretary of State or other official having custody of corporate records in the state or country under whose law it is incorporated. The certificate shall not bear a date of more than one (1) month prior to the date the application is filed in this state.] . (must be month, day and year) . Mailing Address line 1 Mailing Address line 2 City/ State/ Zip Code Name of Corporation Signature and Signature Date Name (typed or printed) and Signer's Capacity SS-4429 (Rev. 1/05) Filing Fee $20 RDA 1678 American LegalNet, Inc. www.FormsWorkFlow.com