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Form F-01 - Application For Certificate Of Authority - 2007, Form Ft-11 - Corporate Franchise Tax - 2006 Page 2

Arkansas Secretary of State

ark

artin

State Capitol • Little Rock, Arkansas 72201-1094

501-682-3409 •

Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock

CORPORATE FRANCHISE TAX

In order for this corporation to receive its annual corporate franchise tax reporting form,

please complete and file with the office of the Secretary of State at the time of incorporation

or qualification

Corporate name

Contact person

Street address or Post Office Box number

City, State, ZIP

Telephone number

E-mail address

NOTE: This tax is due on or before May 1 of the year following incorporation or qualification

in this state.

I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State

is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.

Authorized Officer (Type or Print)

Authorized Signature of Incorporator, Officer or Agent for the Corporation

FT-11 Rev. 4/06

Form F-01 - Application For Certificate Of Authority - 2007, Form Ft-11 - Corporate Franchise Tax - 2006 Page 2