Form 30353 - Certificate Of Assumed Business Name (All Corporations) - Indiana Secretary Of State

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CERTIFICATE OF ASSUMED BUSINESS NAME

SUE ANNE GILROY

SECRETARY OF STATE

(All Corporations)

CORPORATIONS DIVISION

302 W. Washington St., Rm. E018

State Form 30353 (R8 / 9-97)

Indianapolis, IN 46204

Telephone: (317) 232-6576

State Board of Accounts Approved 1995

Indiana Code 23-15-1-1, et seq.

INSTRUCTIONS:

FILING FEES PER CERTIFICATE:

1. This certificate must also be recorded in the office of County Recorder of each

county in which a place of business or office is located.

For-Profit Corporation, Limited Liability

Company, Limited Partnership

$30.00

2. FEES ARE PER ASSUMED NAME. Please make check or money order payable to:

Indiana Secretary of State.

Not-For-Profit Corporation

$26.00

Please TYPE or PRINT.

Certificate - Additional

$15.00

1. Name of Corporation. LLC or LP

2. Date of incorporation / admission

3. Address at which the Corporation,LLC, LP will do business or have an office in Indiana. If no office in Indiana, then state current registered address (street address)

City, state and ZIP code

4. Assumed business name(s) ($30.00 per name)

5. Principal office address of the Corporation, LLC, LP (street address)

City, state and ZIP code

7. Printed name

6. Signature

STATE OF _______________________________________________

SS:

COUNTY OF _____________________________________________

Subscribed and sworn or attested to before me, this _______________________________ day of ____________________________ , 19 _________

Notary Public

My Notarial Commission Expires: