ROSS MILLER Secretary of State 204 North Carson Street, Suite 4 Carson City, Nevada 89701-4520 (775) 684 5708 Website: www.nvsos.gov
Qualification to do Business in Nevada
(PURSUANT TO NRS CHAPTER 80)
USE BLACK INK ONLY - DO NOT HIGHLIGHT ABOVE SPACE IS FOR OFFICE USE ONLY
1. Name of Corporation: (must
be the same as shown on the certificate of existence)
2. State of Incorporation: 3. Registered Agent for Service of Process: (check
only one box)
Commercial Registered Agent:
Noncommercial Registered Agent (name and address below)
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
Street Address Mailing Address (if different from street address) City Zip Code
City Zip Code
4. Authorized Stock: (set forth the
total authorized stock indicating number of par shares, par value per share and/or number of no par shares; mark appropriate box if entity is a nonprofit corporation with or without stock; submit required documentation to support statement; stock statement must match documentation exactly)
Total Authorized Stock: (a) Number of shares with par value: (b) Par value per share:
(c) Number of shares without par value:
If a Nonprofit Entity:
This is a nonprofit entity with authorized stock, as listed above.
This entity is a nonprofit, non-stock corporation.
5. Purpose: (required; The purpose of the corporation shall be:
continue on additional page if necessary)
6. Name, Title and Signature of Officer Name Making Statement:
Title of Officer
7. Certificate of Acceptance of Appointment of Registered Agent:
I hereby accept appointment as Registered Agent for the above named Entity.
Authorized Signature of Registered Agent or On Behalf of Registered Agent Entity Date
This form must be accompanied by appropriate fees.
Nevada Secretary of State NRS 80 Qualification Revised: 4-10-09