Form Cf:0061 - Application For New Authority To Conduct Affairs In Arizona

DO NOT PUBLISH

The purpose of the corporation is to engage in any and all lawful affairs in which corporations

THIS SECTION

may engage in the state or country under whose law the foreign corporation is incorporated,

with the following limitations if any: ___________________________________

6. If the purpose of

your corporation has

__________________________________________________________________________

any limitations with

regard to this section,

The names and usual business addresses of the current directors and officers of the foreign

so indicate. If none

corporation are: (Attach additional sheets if necessary.)

state no limitations, or

leave blank.

Name:

[title]

Address: _________________________________________________________

8. The Application must

indicate if the

City, State, Zip_____________________________________________________

corporation does or

does not have

members.

Name:

[title]

Address: _________________________________________________________

The Application must be

accompanied by the

City, State, Zip_____________________________________________________

following:

A Certificate of

Name:

[title]

Disclosure, executed

within 30 days of its

Address: _________________________________________________________

delivery to the

City, State, Zip_____________________________________________________

Commission, by

a duly authorized officer

A certified copy of

(Check one) The corporation does have members  does NOT have members.

your articles of

incorporation, all

The character of business the foreign corporation initially intends to conduct in Arizona is:

amendments and

mergers (AZ Const. Art.

________________________________________________________________________

XIV, §8) and a

certificate of existence

or document of similar

import duly

Dated this ________ day of ______________________, ______.

authenticated (within 60

days of its delivery to

the A.C.C.) by the

Signature: _______________________________________________________

official having custody

[must be signed by a duly authorized Officer ]

of corporate records in

the state or country

__________________________________

____________________________

under whose laws the

[print name]

[title]

corporation is

incorporated.

PHONE ___________________________

FAX ________________________

The agent must consent

[optional]

to the appointment by

signing the consent

ACCEPTANCE OF APPOINTMENT BY STATUTORY AGENT

ARS §10-140 requires

The undersigned hereby acknowledges and accepts the appointment as statutory agent of this

that changes to

corporation(s) be signed

by a duly authorized

corporation effective this

day of

officer of the

Corporation.

____________________________________

[Signature]

[Print Name]

_____________________________________________________________________________

[If signing on behalf of a company, print company name here]

CF:0061

Arizona Corporation Commission

Rev: 04/2010

Page 3 of 3

Corporations Division

Form Cf:0061 - Application For New Authority To Conduct Affairs In Arizona - 2010 Page 2

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