Certificate of Authority Form Foreign (non-vermont) corporation Vermont Secretary of State, 81 River Street, Montpelier, VT 05609-1104 - 802-828-2386 CORPORATE NAME Created and existing under the laws of: : Date of Incorporation: Business description: Profit corporation g c d e f Non-profit corporation g c d e f Principal Office Address: City State Zip Code NAME OF REGISTERED AGENT: Registered office address: City The Fiscal month: december VERMONT Zip Code Note: December will be designated unless stated differently. FOREIGN BANK AUTHORITY. Name of deceased individual: NAME and ADDRESS of current officers and directors: Pres V.P. Sec. Trea Dir. Dir. Dir. The person submitting this form should enter his or her name and title and sign: Printed Name Title Signature ________________________________________________________Date: NOTE: $100. fee and a certificate of good standing, dated within 30 days of filing, must be attached to application. email or phone where you may be reached: American LegalNet, Inc. www.USCourtForms.com