Form C002.001 - Application For Reservation - Arizona Corporation Commission 2010

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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.

ANNUAL REPORT EXTENSION REQUEST

Read the Instructions

C002i

ENTITY NAME - give the exact name of the corporation as shown in A.C.C. records:

A.C.C. FILE NUMBER:

Find the A.C.C. file number on the upper corner of filed documents OR on our website at:

ANNUAL REPORT DUE DATE (mm/dd/yyyy):

ANNUAL REPORT FILING FEE - this Extension Request form has no separate filing fee,

but payment of the Annual Report fee must be delivered to the A.C.C. with the Extension Request

or the extension will not be granted.

SIGNATURE:

By the signature appearing below, the corporation certifies that it is unable to file its

annual report on or before the due date, and requests a six (6) month extension

of time in which to file its annual report.

By checking the box marked "I accept" below, I acknowledge under penalty of

perjury that this document together with any attachments is submitted in

compliance with Arizona law.

I ACCEPT

Signature

Printed Name

Date (mm/dd/yyyy)

REQUIRED - check only one:

I am a duly authorized

I am the Chairman of the Board

I am a duly-authorized Officer of

of Directors of the corporation

the corporation filing this document.

bankruptcy trustee, receiver, or

filing this document.

other court-appointed fiduciary for

the corporation filing this

document.

Filing Fee: None (regular processing)

Mail:

Arizona Corporation Commission - Corporate Filings Section

Expedited processing – add $35.00 to filing fee.

1300 W. Washington St., Phoenix, Arizona 85007

All fees are nonrefundable - see Instructions.

Fax:

602-542-4100

Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain

to the individual needs of your business.

All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.

If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.

C002.001

Arizona Corporation Commission – Corporations Division

Rev: 2010

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