Utah Division of Corporations & Commercial Code Box 146705, Salt Lake City, Utah 84114-6705 Entity Number ANNUAL REPORT / RENEWAL FORM Entity Type Renewal Fee Expiration Date LATE DATE & FEE SUBMIT SEPARATE PAYMENTS & SEPARATE COUPONS FOR MULTIPLE RENEWALS LLC DESIGNATED / PRINCIPAL OFFICE ADDRESS Entity Name: (Print name exactly as filed) Signature: (Required for LLCs & LPs) Printed Name & Title of Managing Authority (LLC) or General Partner (LP) PLEASE READ THE INSTRUCTIONS CAREFULLY INSTRUCTIONS FOR ANNUAL REPORT / RENEWAL FORM ENTITY NUMBER: This is the number issued to your business entity or trademark, either a 6 or 7 digit number followed by a hyphen and another 4 digit number. ENTITY TYPE: This is the type of entity that you are renewing RENEWAL FEE: Domestic & Foreign Profit Corporations Domestic & Foreign Non-Profit Corporations Domestic & Foreign LLC Domestic & Foreign LP DBA Domestic & Foreign LLP Business Trust Trademark $12.00 $ 7.00 $12.00 $12.00 $22.00 $22.00 $22.00 $22.00 Late Fee Late Fee Late Fee Late Fee Late Fee Late Fee Late Fee Late Fee $10.00 $10.00 $10.00 $10.00 $ N/A $ N/A $ N/A $ N/A EXPIRATION DATE: This is the date that the renewal is due (Anniversary date of the entity) LATE DATE & FEE: This is the date at which the renewal is overdue (see list above for applicable late fees) ENTITY NAME: This is the name of the entity that you are renewing SIGNATURE: LLCs & LPs must be signed by an authorized party - include the person’s printed name & title on the line provided DESIGNATED OFFICE: Domestic LLCs must provide their Designated Office Address, Foreign LLCs must provide their Principal Office Address TIMELY RENEWAL: Pursuant to Utah Law, all renewals must be filed within their legally prescribed time. Failure to do so may result in the loss of all protection and privileges in the State of Utah CHANGES: The Registration Information Change Form is used to make changes to your filing. Download: http://www.corporations.utah.gov Orders: orders@utah.gov or (801) 530-4849, toll free in-state (877) 526-3994 There is no fee involved with the Registration Information Change Form when it is filed in conjunction with the Annual Report / Renewal form during the entity’s renewal period. However, if the Registration Information Change Form is filed at any other time during the year, the $12.00 non-refundable processing fee is still applicable. OTHER: Carefully detach Renewal Coupon and submit to the Division of Corporations with the appropriate fee. For multiple renewals please submit separate payments. Payments are accepted by check or money order and should be payable to “State of Utah.” DO NOT SEND CASH. Please indicate entity number and/or entity name on check. If you are faxing you must include a cover sheet with the number of a Visa, MasterCard or American Express and the date of expiration (Fax (801) 530-6438). If you have questions concerning this renewal or would like to check the status of your record please contact the Corporations Information Center at: (801) 530-4849 or toll free in-state (877) 526-3994 or go to http://www.utah.gov/serv/bes. Forms may be downloaded from our Web site: http://www.corporations.utah.gov Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, the business entity physical address may be provided rather than the residential or private address of any individual affiliated with the entity. American LegalNet, Inc. www.FormsWorkflow.com