Form Ss984 - Transmittal Information For All Business Filings, Form Ss399 - Articles Of Incorporation, Form Ss341 - Domestic Business Corporation Initial Report, Page 4

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Tom Schedler
Secretary of State
DOMESTIC BUSINESS CORPORATION INITIAL REPORT
(R.S. 12:25 AND 12:101)
1. The name of this corporation is:
2. The location and municipal address (not a P.O. Box only) of this corporation’s registered office:
3. The full name and municipal address (not a P. O. Box only) of each of this corporation’s registered
agent(s) is/are:
4. The names and municipal address (not a P.O. Box only) of the first directors are:
Incorporator(s) signature(s)
AGENT’S AFFIDAVIT AND ACKNOWLEDGEMENT OF ACCEPTANCE
I hereby acknowledge and accept the appointment of registered agent for and on behalf of the above
named corporation.
Registered agent(s) signature(s):
Sworn to and subscribed before me, the undersigned Notary Public, on this date:
NOTARY NAME MUST BE TYPED OR PRINTED WITH NOTARY #
Notary Signature
SS341 Rev. 09/11
(See instructions on back)

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