State of Utah DEPARTMENT OF COMMERCE Division of Corporations & Commercial Code Application for Registration of Corporate Name Check Here if: Non-Refundable Processing Fee: [ ] New Filing $22.00 [ ] Renewal $22.00 File Number: This application does not register or renew a business filing When approved, your Registered Name is effective until December 31st of current year. Pursuant to provisions of Utah law (U.C.A. Section 16-10a-1507), the undersigned corporation hereby applies to register its corporate name through and including December 31, 20____, and states as follows: The name of the corporation is: It is incorporated under the laws of the state of: The date of its incorporation is: The business in which it is engaged is: This application is accompanied by a certificate setting forth that this corporation is in existence under the laws of the state of _____________________________ wherein it is incorporated, which is executed by the state agency having custody of the records pertaining to corporations in that state. The certificate of existence must not be older than 90 days. Applicant Information: Applicant/Owner: Name: ___________________________________________________________________________ Entity Number (if a registered business): ________________________________________________ Address: _________________________________________________________________________ City: ______________________________________________ State: ________ Zip: ____________ Under penalties of perjury, I declare that this Application for Registration of Corporate Name has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. Signature: Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. Mailing/Faxing Information: www.corporations.utah.gov/contactus.html Division's Website: www.corporations.utah.gov 01/14 American LegalNet, Inc. www.FormsWorkFlow.com