Form Cr2e081 - Corporation Reinstatement-Florida Department Of State - 2008

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FLORIDA DEPARTMENT OF STATE

CORPORATION

Secretary of State

REINSTATEMENT

DIVISION OF CORPORATIONS

DOCUMENT #

Corporation Name

Principal Office Address - No P.O. Box #

Mailing Office Address

CR2E081 (1/07)

Suite, Apt. #, etc.

Date Incorporated or Qualified

To Do Business in Florida

City & State

FEI Number

Applied For

Not Applicable

Zip

Country

Zip

Country

$8.75

Additional Fee required

CERTIFICATE OF STATUS DESIRED

for a Certificate of Status

Name and Address of Current Registered Agent

Name

The reinstatement fee is imposed, except in

circumstances which the entity did not receive

Street Address (P.O. Box Number is Not Acceptable)

the prior notices. By checking this box, you

are certifying the prior notices were not

Suite, Apt. #, Etc.

received and requesting the reinstatement

fee be waived.

City

State

Zip Code

I, being appointed the registered agent of the above named corporation, am familiar with and accept the obligations of section 607.0505 or 617.0503, F.S.

Signature of

Registered Agent _______________________________________________________________________________________

Date ______________________________________

REGISTERED AGENT MUST SIGN

Names and Street Addresses of Each Officer and/or Director (Florida nonprofit corporations must list at least 3 directors)

Name of

Street Address of Each

Titles

City / State / Zip

Officers and /or Directors

Officer and /or Director

10.

I certify that I am an officer or director or the receiver or trustee empowered to execute this application as provided for in chapter 607 or 617, F.S. I further certify that when filing

this reinstatement application, the reason for dissolution has been eliminated, the corporate name satisfies the requirements of section 607.0401 or 617.0401, F.S., that all fees

owed by the corporation have been paid and the names of individuals listed on this form do not qualify for an exemption contained in Chapter 119, F.S. The information indicated

on this application is true and accurate, and my signature shall have the same legal effect as if made under oath.

SIGNATURE:

____________________________________________________________________________________________________________________________________

SIGNATURE AND TYPED OR PRINTED NAME OF SIGNING OFFICER OR DIRECTOR

Date

Daytime Phone #