Form Nrs 80 - Qualification To Do Business In Nevada

Form Nrs 80 - Qualification To Do Business In Nevada - 2005

DEAN HELLER

Secretary of State

206 North Carson Street

Carson City, Nevada 89701-4299

(775) 684 5708

Website: secretaryofstate.biz

Qualification to do

Business in Nevada

(PURSUANT TO NRS 80)

Important: Read attached instructions before completing form.

ABOVE SPACE IS FOR OFFICE USE ONLY

1. Name of Corporation:

(must be the same as shown on

the certificate of existence)

2. State of

Incorporation:

3. Resident Agent Name

and Street Address:

(must be a Nevada address

________________________________________________________________________________

where process may be served)

Name

__________________________________________________________, NEVADA ___________

Physical Street Address

City

Zip Code

__________________________________________________________, ________ ____________

Additional Mailing Address

City

State

Zip Code

Authorized Stock:

_________________________________________________

Total authorized stock:

(set forth the total authorized

stock, indicating number of par

shares, par value per share

_____________________________________

and/or number of no par shares;

(a) Number of shares with par value:

check box if entity is a nonprofit,

non-stock corporation; please

attach required documentation)

$__________________________________________

(b) Par value of each share:

___________________________________

This entity is a nonprofit, non-stock corporation.

The purpose of this Corporation shall be:

5. Purpose:

6. Name, Title &

____________________________________

_________________________________________

Signature of

Name

Title

Officer Making

Statement:

____________________________________

Signature

7. Certificate of

I hereby accept appointment as Resident Agent for the above named corporation.

Acceptance of

Appointment of

___________________________________________________

________________________________________

Resident Agent:

Authorized Signature of R.A. or On Behalf of R.A. Company

Date

This form must be accompanied by appropriate fees.

Nevada Secretary of State NRS 80 Form 2003

Revised on: 09/29/05

Form Nrs 80 - Qualification To Do Business In Nevada - 2005

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