Free Form - Nevada

ROSS MILLER Secretary of State 204 North Carson Street, Suite 1 Carson City, Nevada 89701-4520 (775) 684 5708 Website: www.nvsos.gov

Appointment of Registered Agent
by Nonfiling Domestic and Nonqualified Foreign Entities (PURSUANT TO NRS 77.380)
USE BLACK INK ONLY - DO NOT HIGHLIGHT ABOVE SPACE IS FOR OFFICE USE ONLY

1. Name of Nonfiling or Nonqualified Entity:

2. Entity Type: 3. Jurisdiction of Organization: 4. The above named entity appoints the following agent for service of process in Nevada: (please complete a, b or c) a) Commercial Registered Agent:
Name

b) Noncommercial Registered Agent:
Name

Nevada
Street Address City Zip Code

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

c) Title of Office or Other Position with Entity:
Name of Title or Position

Nevada
Street Address City Zip Code

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

5. This statement remains in effect for a period of 5 years after the date of filing unless canceled earlier or terminated by qualification. 6. Entity Signature:

X
Authorized Signature of Nonfiling or Nonqualifying Entity
Date

7. 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

Fee: $60.00
This form must be accompanied by appropriate fees.

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Nevada Secretary of State Form RA Misc Appointment Effective 5-15-09