STATE OF OHIO
Department of Commerce
Division of Securities
77 South High Street, Columbus, Ohio 43215-6131
Irrevocable Consent to Service of Process by Non-Resident
Applicant for Registration of Securities Under Chapter 1707.
Know All Men by These Presents: That in compliance with the provisions of Section 1707.11 of the Revised Code of Ohio, the undersigned,
being the applicant for the registration or exemption of securities under Chapter 1707. and
being the issuer of the securities described in said application, and being
does hereby irrevo-
cably consent that suits and actions growing out of the sale of such securities or fraud committed by an applicant in this state may be
commenced against the undersigned in the proper court of any county in this state in which a cause of action may arise, or in which the
plaintiff may reside, and that service of any process or pleading in any such cause of action and authorized by the laws of the State of Ohio may
be served on the Secretary of State of the State of Ohio; and it is hereby further irrevocably stipulated and agreed that such service of such
process or pleading on the Secretary of State of Ohio shall be taken and held in all courts to be as valid and binding as if service had been made
upon the undersigned issuer itself. Undersigned further hereby irrevocably appoints the said Secretary of State of the State of Ohio, or his
successor in office, its/his attorney in fact within the State of Ohio upon whom any such process or pleading and duly authorized by the laws
of Ohio may be served in any such cause or action.
In witness whereof this instrument is duly executed by its proper officers according to due authority granted and existing therefore
, before me, a notary public in and for said county and state, per-
to be known to be the person who executed the foregoing instrument, who,
being by me duly sworn, says that said instrument was executed on behalf of
by authority of
and acknowledged said instrument to be his free act and deed and the free act and deed of said
This consent must be accompanied by a certified copy of the resolution of the Board of Directors, Trustees or manager of the corporation or
association, authorizing such individual to execute the same, if the issuer is a corporation or an unincorporated association.
If this consent is being filed by a foreign corporation, insert “a corporation organized and existing under the laws of the State
.” If consent is filed by an unincorporated issuer, insert “a
having the situs of its principal place of business at, State of
Name of Issuer.
“Board of Directors,” “trustees,” “managers,” etc.