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APPLICATION FOR CERTIFICATE OF AUTHORITY OF A FOREIGN CORPORATION
State For m 387 84 (R9 / 12-02) Co rpora te F orm 112 Ap proved By S tate Board Of Accounts, 1995

TODD ROKITA SE CRETARY OF STATE CORPORATIONS DIVISION 302 W. Wa shi ngton St., Rm . E01 8 Indian apolis, IN 462 04 Teleph one: (31 7) 2 32-65 76 Indian a Code 23 -1-49-1 et seq . 23-1 -49-3

Filing Fee: $90.00 NOTES: 1. An Original Certificate of Existence duly authenticated by the proper authority from corporation's domicilary state within the last sixty (60) days must be submitted with this application. 2. A Registered Agent with an Indiana street address (not a PO BOX) must be listed in ARTICLE III. INSTRUCTIONS: Use 8 1/2" x 11" white paper for attachments. Present original and one copy to address in the upper right corner of this form. Please TYPE or PRINT. Please visit our office on the web at www.sos.in.gov.

APPLICATION FOR CERTIFICATE OF AUTHORITY OF

A FOREIGN CORPORATION TO TRANSACT BUSINESS IN THE STATE OF INDIANA The undersigned officer of the above corporation which was formed as:

A general business corporation

A professional corporation

desiring to effectuate the admittance of the Corporation to transact business in the State of Indiana, certifies the following facts:

ARTICLE I: Name
Name of Corpor atio n ( Must be identical to name shown i n Articles of Incorpo ration and A me ndments thereto)

ARTICLE II: Address of Corporation
Addre ss of the p rincipal office o f corpora tion (Number and street, city, state and ZIP cod e)

ARTICLE III: Registered Office and Registered Agent
Name o f th e Regi stered Ag ent of the corpor atio n (can not be the co rporation itse lf)

In diana ad dress of the registered office of corpor atio n (Numbe r an d street, city; P.O. Box not accepte d))

ZIP code

INDIANA ARTICLE IV: Date and State of Incorporation and Duration of Existence
Date o f incorpor atio n i n do mi cila ry state: S tate of incorp oration

Expected period of duration liste d in the A rticles o f Incorpo ration (per petual, term o f years or da te certain e.g . Dece mb er 3 1, 205 0)

ARTICLE V: Corporate Officers The names and business addresses of the officers of the Corporation: Name Title Address (Number, street, city state and ZIP code) ,

ARTICLE VI: Board of Directors The names and business addresses of the Board of Directors of the Corporation are as follows: Name Address (Number, street, city, state and ZIP code)

In witness whereof, the undersigned being the___________________________________________________ of said Corporation executes this
(Ti tle: officer or Cha irman of Boa rd)

Application For Certificate Of Authority, and verifies subject to penalties of perjury, that the facts contained herein are true this __________________day of __________________________ , 20 _____.
S ig na ture Prin te d n ame