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Application For Certificate Of Authority Foreign Corporation - Professional - District Of Columbia Page 2

9. Brief statement of the business it proposes to transact in the District: __________________________

_______________________________________________________________________________

10. All officers, directors and shareholders of the corporation are licensed to practice the profession for

which the corporation is incorporated. In the case of a single person corporation, the Secretary of the

corporation need not be so licensed.

11. Attach to this application an original Certificate of Goodstanding, dated within the last 30 days, by

the proper authority in the State/County of incorporation.

12. Attach a list of the names and addresses (including street and number) of all officers and directors of

the corporation.

Corporate Name ___________________________________________________________________

Signature of President or Vice President __________________________________________________

(Corporate Seal)

FEES DUE

Filing Fee .........$150.00

MAKE CHECK PAYABLE TO D.C. TREASURER

Application For Certificate Of Authority Foreign Corporation - Professional - District Of Columbia Page 2