Tre Hargett, Secretary of State Business Services Division For Office Use Only APPLICATION FOR REGISTRATION OF FOREIGN LIMITED LIABILITY COMPANY NAME 312 Rosa L. Parks Avenue, 6th Floor Nashville, Tennessee 37243 State of Tennessee To the Secretary of State of the State of Tennessee: Pursuant to the provisions of §48-249-108 of the Tennessee Revised Limited Liability Company Act, the undersigned limited liability company hereby applies for the registration of its limited liability company name or assumed limited liability company name to and including December 31, and submits the following statement: 1. The name of the Limited Liability Company 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 State from the limited liability company names that are not available under §48-249-106(b) of the Tennessee Revised Limited Liability Company Act. 2. The state or country of the organization is: 3. The date of organization is: Month Day , Year 4. The nature of the business of the limited liability company is: NOTE: This application must be accompanied by a certificate of existence (or document of similar import) duly authenticated by the Secretary of State or other official having custody of limited liability company records in the state or country under whose law it is organized. The certificate shall not bear a date of more than one (1) month prior to the date the application is filed in this state. Name of Limited Liability Company: Mailing Address: Mailing Address Line 2: City: Signature Signer's Capacity (if other than individual capacity): State: Zip Code: Date: SS-4236 (Rev. 04/10) Filing Fee $20.00 RDA 2458 American LegalNet, Inc. www.FormsWorkFlow.com