Form 08-414 - Certificate Of Authority Foreign Business Corporation/form 08-561 - Contact Information Sheet - 2013 Page 4

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ITEM 7: Name and address of each alien affiliate (if there are no alien affiliates, indicate “none”):
Name:
Mailing address:
City:
State/Province:
Country:
Attach additional sheet if more than one alien affiliate.
ITEM 8: Number of authorized shares (zero is not an acceptable quantity):
Common
Preferred
# of Authorized shares
Class
Series
Par value
Common
Preferred
# of Authorized Shares
Class
Series
Par value
ITEM 9: Number of issued shares; if shares have been issued, complete item #10, Shareholders:
# of Issued Shares
Class
Series
Par Value
# of Issued Shares
Class
Series
Par Value
ITEM 10: Name and address of each person/entity owning 5% or more of the issued shares or 5% of any class
of issued shares and the percentage of the issued shares owned by that person. If there are no person/entity
owning 5% or more please indicate with “NONE”. If you have shareholders Item #9 must be completed.
%
Issued
Name
Mailing address
City
State
ZIP code
shares held
Attach additional sheet if necessary.
ITEM 11: The names and mailing addresses of the officers and directors of the corporation:
Title
Name
Mailing address
City
State
ZIP code
President
Vice President
Secretary
Treasurer
Director
Director
If necessary, attach additional pages for continuation. Please do not include confidential information such as
Social Security Numbers, driver license numbers or date of birth as this record is public information.
08-414 (Rev. 01/07/2013)
Page 2 of 3

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