Form Ss984 - Transmittal Information For All Business Filings, Form Ss395 - Articles Of Incorporation Page 3
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4Incorporator(s) Signature(s):
On this ________ day of __________________________________, 20___, before me, personally
appeared_____________________________________________, to me known to be the person
described in and who executed the foregoing instrument, and acknowledged that he executed it
as his free act and deed.
Notary
AGENT’S AFFIDAVIT AND ACKNOWLEDGEMENT OF ACCEPTANCE
I hereby acknowledge and accept the appointment of registered agent for and on behalf of the above
named corporation.
Registered agent(s) signature(s):
Sworn to and subscribed before me this __________day of ________________________, 20_____.
NOTARY NAME MUST BE TYPED OR PRINTED WITH NOTARY #
Notary Signature
Page 2 of 2
SS395B Rev. 08/13
(See instructions on back)
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