Annual List Of Officers, Directors And Resident Agent Form - Nevada - 2000

FILE NUMBER

ANNUAL LIST OF OFFICERS, DIRECTORS AND RESIDENT AGENT OF

(NONPROFIT)

_____________________________________________________________________

_____________________

(Name of Corporation)

A _______________________________NONPROFIT CORPORATION

FOR THE FILING PERIOD _________________TO________________

(State of Incorporation)

The corporation’s duly appointed resident agent in the State of Nevada

Office Use Only

upon whom process can be served is:

IF AGENT INFORMATION HAS CHANGED, PLEASE SEE ATTACHED

INSTRUCTIONS ON HOW TO OBTAIN THE APPROPRIATE FORM.

Important: Read instructions before completing and returning this form.

1. Print or type names and addresses, either residence or business, for all officers and directors. A president, secretary, treasurer and at least one director must be named. Have an officer sign the form.

FORM WILL BE RETURNED IF UNSIGNED

2. If there are additional directors attach a list of them to this

form..

3. Return the completed form with the $15.00 filing fee. A $5.00 penalty must be added for failure to file this form by the last day of the anniversary month of incorporation/registration with this office.

4. Make your check payable to the Secretary of State. Your cancelled check will constitute a certificate to transact business. If you need a receipt, return page 2 certificate and ENCLOSE A SELF- ADDRESSED

STAMPED ENVELOPE. To receive a certified copy, enclose a copy of this completed form, an additional $10.00 and appropriate instructions.

5. Return the completed form to: Secretary of State, 101 North Carson Street, Suite 3, Carson City, NV 89701-4786, (775) 684-5708.

FILING FEE: $15.00

LATE PENALTY: $5.00

NAME

TITLE(S)

PRESIDENT

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

NAME

TITLE(S)

SECRETARY

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

NAME

TITLE(S)

TREASURER

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

NAME

TITLE(S)

DIRECTOR

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

NAME

TITLE(S)

DIRECTOR

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

NAME

TITLE(S)

DIRECTOR

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

I hereby certify this annual list.

X Signature of officer

Title(s)

Date

Nevada Secretary of State Form ANNUAL LIST-NONPROFIT1999.01

Revised on: 01/11/00