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Application For Registration Of Corporate Name Foreign Corporation - Connecticut Secretary Of The State - 2009

APPLICATION FOR REGISTRATION OF

CORPORATE NAME

FOREIGN CORPORATION

Office of the Secretary of the State

MAILING ADDRESS:

DELIVERY ADDRESS:

Commercial Recording Division

Connecticut Secretary of the State

P.O. Box 150470

30 Trinity Street

Hartford, CT 06115-0470

Hartford, CT 06106

860-509-6003

FEE: $60.00

Make Checks Payable To “Secretary of the State”

Space For Office Use Only

The undersigned hereby applies for registration of the following corporate name.

1. CORPORATE NAME:

2. STATE OR COUNTRY OF INCORPORATION:

3. DATE OF INCORPORATION: _____/_____/___________ (mo./day/yr.)

4. THE NATURE OF BUSINESS IN WHICH THE CORPORATION IS ENGAGED:

(Please reference an 8 1/2 X 11 attachment if additional space is needed)

5. ADDRESS OF THE CORPORATION:

6. EXECUTION:

Dated this_______________day of ____________, 20______.

Print or type name of signatory

Capacity of signatory

Signature

INSTRUCTIONS:

Please return completed registration form to the Office of the Secretary of the

State at the above referenced address.

The application must be accompanied by a Certificate of Existence issued by the

official keeper of corporate records in the state or country of the corporation's formation.

This Certificate may not be more than 90 days old at the time of filing.

A registration of corporate name expires at the end of the calendar year

in which an application is filed.

Please type or print all information other than the signature.

REV. 12/07/09

Application For Registration Of Corporate Name Foreign Corporation - Connecticut Secretary Of The State - 2009