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Form 173-Fce - Verification Of Continued Existence Of Foreign Non-Profit Corporation Licensed In Ohio

J. Kenneth Blackwell

Prescribed by

Please obtain fee amount and mailing instructions from the Forms

Inventory List (using the 3 digit form # located at the bottom of this

form). To obtain the Forms Inventory List or for assistance, please

call Customer Service:

Central Ohio: (614)-466-3910 Toll Free: 1-877-SOS-FILE (1-877-767-3453)

VERIFICATION OF CONTINUED EXISTENCE

of Foreign Non-Profit Corporation Licensed in Ohio

The exact corporate name is

The state of incorporation is

The date on which the corporation qualified to transact business in Ohio is

The principal location for the corporation is:

(street name and number)

(city, township, or village)

(state)

(zip code)

The principal location in Ohio for the corporation is:

(street name and number)

, Ohio

(city, village or township)

(zip code)

The corporation is still actively engaged in exercising its corporate privileges in Ohio.

The current statutory agent is

The agent's address is:

(street name and number)

, Ohio

(city, village or township)

(zip code)

NOTE: P.O. Box addresses are not acceptable

This document is signed by a corporate officer.

Signature:

Name:

173-FCE

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Version: 7/15/99

Form 173-Fce - Verification Of Continued Existence Of Foreign Non-Profit Corporation Licensed In Ohio