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Interim Notice Of Change Of Officer/director - Domestic And Foreign Corporations - Connecticut Secretary Of The State Page 2

INSTRUCTIONS FOR COMPLETION OF THE INTERIM

NOTICE OF CHANGE OF OFFICER/DIRECTOR FORM

Domestic and Foreign Corporations

Instructions correspond with numbered entries on the form

NAME OF CORPORATION: Please provide the complete name of the corporation as it

currently appears on the records of the Secretary of the State. If the notice is being filled

by a foreign corporation, such corporation should provide the name under which it is

currently authorized to transact business in Connecticut.

NEW OFFICER/DIRECTOR INFORMATION: Please print or type the full name of the

corporation's officers and directors, their titles, including a check following the statement

"Check if Director" if applicable, and their residence and business addresses. Complete

street addresses including a street number, street name, city, state, postal code and

country if other than the United States are required. Note: P.O. boxes are only

acceptable as additional information.

DIRECTORS/OFFICERS WHO HAVE CEASED TO HOLD OFFICE: Please print or

type the full name of directors/officers who have ceased holding director or officer

positions within the corporation and their titles, including a check following the

statement "Check if Director" if applicable.

EXECUTION:

The document must be executed by an authorized official of the

corporation. That person must print or type their name, state the capacity under which

they sign. The execution constitutes a legal statement under the penalties of false

statement that the information provided in the document is true.

Revised 11/2007

Interim Notice Of Change Of Officer/director - Domestic And Foreign Corporations - Connecticut Secretary Of The State Page 2