Form Fco - Certificate Of Authority For Profit/nonprofit/professional Service Corporation (Foreign Business Corporation) - 2010

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OMMONWEALTH OF

ENTUCKY

, S

REY

RAYSON

ECRETARY OF

TATE

__________________________________________________________________________________________________________________________

Division of Corporations

Certificate of Authority for

FCO

Business Filings

Profit/Nonprofit/Professional Service Corporation

PO Box 718

Frankfort, KY 40602

(Foreign Business Corporation)

(502) 564-3490

Pursuant to the provisions of KRS Chapter 271B, 273 or 274, the undersigned hereby applies for authority to transact business in Kentucky on behalf of the

corporation named below and, for that purpose, submits the following statements:

1. The corporation is:

profit corporation (KRS 271B).

nonprofit corporation (KRS 273).

professional service corporation (KRS 274).

2. The name of the corporation is____________________________________________________________________________________________________.

3. The name of the corporation to be used in Kentucky is (if applicable):______________________________________________________________________.

(Only provide if "real name" is unavailable for use; otherwise, leave blank.)

4. The state or country under whose law the corporation is incorporated is____________________________________________________________________.

5. The date of incorporation is _______________________________________and the period of duration is _________________________________________.

6. The mailing address of the corporation’s principal office is

_______________________________________________________________________________________________________________________________.

Street Address

City

State

Zip Code

7. The street address of the corporation’s registered office in Kentucky is

_______________________________________________________________________________________________________________________________.

Street Address (No P.O. Box Numbers)

City

State

Zip Code

and the name of the registered agent at that office is _____________________________________________________________________________________.

8. The names and business addresses of the corporation’s current officers and directors are as follows:

_______________________________________________________________________________________________________________________________

Name

Street or P.O. Box

City

State

Zip Code

_______________________________________________________________________________________________________________________________

Name

Street or P.O. Box

City

State

Zip Code

_______________________________________________________________________________________________________________________________

Name

Street or P.O. Box

City

State

Zip Code

9. If a professional service corporation, all the individual shareholders, not less than one half (1/2) of the directors, and all of the officers other than the secretary

and treasurer are licensed in one or more states or territories of the United States or District of Columbia to render a professional service described in the

statement of purposes of the corporation.

10. A certificate of existence duly authenticated by the Secretary of State accompanies this application.

11. This application will be effective upon filing, unless a delayed effective date and/or time is provided. The effective date or the delayed

effective date cannot be prior to the date the application is filed. The date and/or time is ______________________________.

)

(Delayed effective date and/or time

____________________________________________________________________________________________________

Signature of Officer or Chairman of the Board

Printed Name & Title

Date

I, _________________________________________________________, consent to serve as the registered agent on behalf of the corporation.

Type/Print Name of Registered Agent