Free Form - Nevada

ROSS MILLER Secretary of State 204 North Carson Street, Suite 4 Carson City, Nevada 89701-4520 (775) 684 5708 Website: www.nvsos.gov

Application of Registration for Foreign Business Trust
(PURSUANT TO NRS 88A.710)
USE BLACK INK ONLY - DO NOT HIGHLIGHT ABOVE SPACE IS FOR OFFICE USE ONLY

1. Name of Foreign Business Trust: 2. Name Being Registered with Nevada:
The name under which this foreign business trust proposes to register and transact business in Nevada:

3. Date and State or Country of Formation: 4. Registered Agent for Service of Process: (check
only one box)

Date Formed Commercial Registered Agent:
Name

State or Country where Authorized

Noncommercial Registered Agent (name and address below)

OR

Office or Position with Entity
(name and address below)

Name of Noncommercial Registered Agent OR Name of Title of Office or Other Position with Entity

Nevada
Street Address Mailing Address (if different from street address) City Zip Code

Nevada
City Zip Code

5. Street Address of Principal Office: (or
office registered to be maintained in the domicile state by the laws of that state) Street Address City State Zip Code

6. Name and Address of each Trustee: (attach
additional page if more than 2)

1)
Name Address City State Zip Code

2)
Name Address City State Zip Code

7. Name and Signature of Trustee: 8. Certificate of Acceptance of Appointment of Registered Agent:

X
Name Authorized Signature

I hereby accept appointment as Registered Agent for the above named Entity.

X
Authorized Signature of Registered Agent or On Behalf of Registered Agent Entity Date

This form must be accompanied by appropriate fees.

Reset

Nevada Secretary of State NRS 88A FBT Registration Revised: 4-20-09