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Form Pc-01 - Application For Certificate Of Authority Foreign Professional Corporation - 2000 Page 3

__________________________

(site of acknowledgment)

__________________________

This ____ day of ______________, 20____, personally came before me, ______________________________________,

Notary Public, __________________________________, who, being by me duly sworn, says that he/she is

____________________________ of __________________________________________________, a corporation, and

that this application for certificate of authority was signed by him/her on behalf of the corporation by its authority duly

given. And the said _________________________ acknowledged the said writing to be the act and deed of said

corporation.

Witness my hand and official seal, this the ____ day of ________________, 20____.

(Official Seal)

____________________________________________________

Notary Public

My commission expires _______________, 20____.

Notes:

1. Filing fee is $250. This document must be filed with the Secretary of State.

2. For additional instructions, see the following page of this form.

(Revised January 2000)

(Form PC-01)

CORPORATIONS DIVISION

P.O. BOX 29622

RALEIGH, NC 27626-0622

PC-01

Form Pc-01 - Application For Certificate Of Authority Foreign Professional Corporation - 2000 Page 3