Certificate Of Reinstatement Form - Stock Or Non-Stock Corporation - 2001

CERTIFICATE OF REINSTATEMENT

STOCK OR NON-STOCK CORPORATION

Office of the Secretary of the State

30 Trinity Street / P.O. Box 150470 / Hartford, CT 06115-0470/Rev. 03/01/2001

See reverse for instructions

Filing Fee: $150.00 Stock

Space For Office Use Only

$80.00 Nonstock

1. NAME OF CORPORATION:

2. PLACE A CHECK MARK NEXT TO A. OR B.:

_____A. The corporation is a Connecticut Stock Corporation.

_____B. The corporation is a Connecticut Non-stock Corporation.

3. APPOINTMENT OF REGISTERED AGENT: (Please select one A. or B.)

A. Individual’s Name:

Business address:

Residence address:

B. Business Entity:

Address:

Acceptance of appointment

_____________________________________________________________

Signature of agent

4. EXECUTION:

Dated this _________________day of ____________________, 20_____.

Print or type name of signatory

Capacity of signatory

Signature

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Parent category: Legal