Form Si-350 - Statement Of Information Page 3

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State of California

Secretary of State

Statement of Information

(Foreign Corporation)

FEES (Filing and Disclosure): $25.00.

If this is an amendment, see instructions.

IMPORTANT – READ INSTRUCTIONS BEFORE COMPLETING THIS FORM

1. CORPORATE NAME

2. CALIFORNIA CORPORATE NUMBER

This Space for Filing Use Only

No Change Statement

(Not applicable if agent address of record is a P.O. Box address. See instructions.)

If there have been any changes to the information contained in the last Statement of Information filed with the California Secretary

of State, or no statement of information has been previously filed, this form must be completed in its entirety.

If there has been no change in any of the information contained in the last Statement of Information filed with the California Secretary

of State, check the box and proceed to Item 13.

Complete Addresses for the Following

(Do not abbreviate the name of the city. Items 4 and 5 cannot be P.O. Boxes.)

STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE

CITY

STATE

ZIP CODE

STREET ADDRESS OF PRINCIPAL BUSINESS OFFICE IN CALIFORNIA, IF ANY

CITY

STATE

ZIP CODE

MAILING ADDRESS OF THE CORPORATION, IF DIFFERENT THAN ITEM 4

CITY

STATE

ZIP CODE

EMAIL ADDRESS FOR RECEIVING STATUTORY NOTIFICATIONS

Names and Complete Addresses of the Following Officers

(The corporation must list these three officers. A comparable title for the specific

officer may be added; however, the preprinted titles on this form must not be altered.)

CHIEF EXECUTIVE OFFICER/

ADDRESS

CITY

STATE

ZIP CODE

SECRETARY

ADDRESS

CITY

STATE

ZIP CODE

CHIEF FINANCIAL OFFICER/

ADDRESS

CITY

STATE

ZIP CODE

Agent for Service of Process

If the agent is an individual, the agent must reside in California and Item 11 must be completed with a California street

address, a P.O. Box address is not acceptable. If the agent is another corporation, the agent must have on file with the California Secretary of State a

certificate pursuant to California Corporations Code section 1505 and Item 11 must be left blank.

[Note: The person designated as the corporation's agent MUST have agreed to act in that capacity prior to the designation.]

10. NAME OF AGENT FOR SERVICE OF PROCESS

11. STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL CITY

STATE

ZIP CODE

Type of Business

12. DESCRIBE THE TYPE OF BUSINESS OF THE CORPORATION

13. THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT.

DATE

TYPE/PRINT NAME OF PERSON COMPLETING FORM

TITLE