Free corp 76 - Missouri

State of Missouri
D WE S T ITE

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Robin Carnahan, Secretary of State
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No. This is to certify that each of the persons named below, as incorporators and/or shareholders of a proposed Professional Corporation named
Name of Corporation

are duly licensed or registered to practice the profession of
Name of Profession

in the State of Missouri with
Name of Board

Name of Incorporator

The above name(s) of Incorporator(s) are hereby approved by this State Board.

Authorized Signature of State Board

Name and address to return filed document: Name: Address: City, State, and Zip Code:
Corp. 76 (11/2008)

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Corporations Division PO Box 778 / 600 W. Main St., Rm. 322 Jefferson City, MO 65102

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Certificate of State Board Registration

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Registration or License Number Date Licensed or Registered Address­ City or Town

Printed Name

Title

Date