Certificate Of Representation For An Artificial Entity Or Public Body

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CERTIFICATE OF REPRESENTATION FOR AN ARTIFICIAL ENTITY OR PUBLIC BODY

IN CIVIL CASES IN THE JUSTICE OF THE PEACE COURT

[PLEASE READ THE INFORMATION ON THE BACK OF THIS FORM BEFORE COMPLETING THE FORM. This certification form

must be completed by an officer of the artificial entity or public body as defined by Supreme Court Rule 57, notarized and the original forwarded to

the Chief Magistrate, 5 East Pine Street, Georgetown, Delaware 19947, along with the $20 annual fee. Check or money order should be made

payable to the Delaware Supreme Court.]

NAME OF BUSINESS (please print):

Co. ID # @

(if previously assigned)

TYPE OF ENTITY; YOU MUST CHECK ONE OF THESE TO BE ELIGIBLE TO USE RULE 57:

__________DE Corporation

__________DE Partnership

__________DE Limited Liability Co.

__________DE Association

__________DE Estate

__________DE Trust

__________DE Public Body

__________Foreign Entity, reg. in DE __________DE Entity with Registered Tradename or Title

PRINCIPAL OFFICE ADDRESS

MAILING ADDRESS (where court notices are to be sent -- if

different than principal office address)

Street Address

City

State

Zip

City

State

Zip

Telephone

Email Address

Telephone

Email Address

APPOINTS

Agent No. FA

(if previously assigned)

NAMED REPRESENTATIVE

The artificial entity or public body, through signature of an officer on this document, ratifies and confirms that the named representative is authorized

to appear on its behalf in all matters before the Justice of the Peace Court, and agrees that it will be bound by the results of that representation. This

certification makes the named representative of the artificial entity or public body an agent only for purposes of this representation. By filing a

certification, the artificial entity or public body and its named representative are subject to the sanctions set forth in Justice of the Peace Court Rules

for inappropriate actions.

The artificial entity/public body, through signature of an officer on this document, certifies and affirms:

(1)

That the artificial entity/public body is in good standing.

(2)

That the named representative has not been disbarred from, or is not currently under suspension or probation with respect to, the practice of

law in any state or jurisdiction within the United States; and has not been convicted of a felony or a crime involving dishonesty or false statement in

the ten (10) year period immediately prior to the appearance of the named representative in the Court; and has not been determined to have engaged

in the unauthorized practice of law in this or any other jurisdiction; and is not an employee whose primary duty is to prosecute or defend Justice of

the Peace Court civil actions; and has not had any prior authorization pursuant to this rule revoked by the Chief Magistrate.

(3)(a)

That the OFFICER is:

(b) That the NAMED REPRESENTATIVE is:

(CHECK ONE)

chief executive, president or chair

vice-president or vice chair

secretary or assistant secretary

treasurer or assistant treasurer

trustee of a trust