Form 114-Arn - Articles Of Incorporation - Non-Profit Corporation Page 3

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J. Kenneth Blackwell
Prescribed by:
J. Kenneth Blackwell
Secretary of State
30 East Broad St. 14th Floor
Columbus, Ohio 43266-0418
ORIGINAL APPOINTMENT OF STATUTORY AGENT
The undersigned, being at least a majority of the incorporators of
(name of corporation)
hereby appoint
to be statutory agent upon whom any process, notice or
demand required or permitted by statute to be served upon the corporation may be served. The complete address of the agent is:
(street address)
, Ohio
(city)
(zip code)
Note: P.O. Box addresses are not acceptable
Signature:
Name:
Signature:
Name:
Signature:
Name:
ACCEPTANCE OF APPOINTMENT
The undersigned,
, named herein as the statutory agent for
, hereby acknowledges and accepts the appointment of
statutory agent for said corporation.
Signature:
Statutory Agent
114-ARN
Page 3 of 3
Version: May 1, 1999

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