Free 26234.PDF - Indiana

REGISTRATION OF FOREIGN CORPORATION NAME
State For m 2623 4 ( R7 / 1- 03) Ap proved by State Board of Accounts, 2001

TODD ROKITA SE CRETARY OF STATE CORPO RATIONS DIVISION 3 02 W. Wa sh ington Stre et, Rm . E018 Indi anapo lis, IN 4 6204 Telepho ne: (31 7) 232-65 76

FILING FEE: $30.00
Indiana Code 23 -1-18-3 A ND 23-1-2 3-3

INSTRUCTIONS: Use 8 1/2" x 11" white paper for attachments. Present original and one (1) copy to the address in the upper right corner of this form. Attach Certificate of Existence or document of similar import from state or country of domicile and send to the 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.
A. Name of Corpor atio n to be registered (Name of Corpora tion as it app ears o n the Article s of Incorpora tion , or th e Amend ed Ar ticles o f In cor poration includin g a dditions re quired by IC 23- 1-49-6 : In cor porated, Cor poration, Compa ny, Limited, Corp., Co., Ltd. and IC 23 -1.5 -2 -8 i f it is a Pro fessional Corpo rati on, the wo rds Pr ofessiona l Corpo ration or P.C.)

B . State or Country o f In cor poration:

C. Addr ess to which corr esp onden ce can be mailed:

D. Date of Inco rporation :

E . A brief de scription of the nature of the business in which the corpo rati on i s enga ged:

NOTE: Registration is for one calendar year, January 1 through Decemeber 31. Registration must be renewed each year by filing a renewal application between October 1 and December 31 for the following year.

In witness whereof, the undersigned being the _____________________________________________________________________
(Title: Offi cer or Directo r)

of said Corporation executes this Registration of Foreign Corporation Name and verifies, subject to the penalties of perjury, that the statements contained herein are true this __________________________________________________________________ day of ____________________________________ , 20 __________ .

Signa ture

Prin ted na me