Application For Certificate Of Authority Of A Foreign Corporation - Indiana Secretary Of State - 1995 Page 2

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ARTICLE V: Board of Directors
The names and business addresses of the Board of Directors of the Corporation are as follows:
Name
Address (Number, street, city, state and ZIP code)
In witness whereof, the undersigned being the___________________________________________________ of said Corporation executes this
(title)
Application For Certificate Of Authority, and verifies subject to penalties of perjury, that the facts contained herein are true this
__________________day of __________________________ , 19 _____.
Signature
Printed name

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