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Application To Renew A Registration Of Corporate Name Foreign Corporation - Connecticut Secretary Of State

APPLICATION TO RENEW A REGISTRATION OF

CORPORATE NAME

FOREIGN CORPORATION

Office of the Secretary of the State

MAILING ADDRESS:

DELIVERY ADDRESS:

Commercial Recording Division

Connecticut Secretary of the State

P.O. Box 150470

30 Trinity Street

Hartford, CT 06115-0470

Hartford, CT 06106

860-509-6003

Refer to Fee Schedule for amount due.

Space for Office Use Only

Make Checks Payable To “Secretary of the State”

The undersigned hereby applies to renew the registration of the following corporate name:

1. CORPORATE NAME:

2. STATE OR COUNTRY OF INCORPORATION:

3. DATE OF INCORPORATION: _____/_____/__________ (mo./day/yr.)

4. THE NATURE OF BUSINESS IN WHICH THE CORPORATION IS ENGAGED:

(Please reference an 8 1/2 X 11 attachment if additional space is needed)

5. ADDRESS OF THE CORPORATION:

6. EXECUTION:

Dated this_______________day of ____________, 20________.

Print or type name of signatory

Capacity of signatory

Signature

INSTRUCTIONS:

Complete and return this registration form to the Office of the Secretary of the

State at the above referenced address. The application must be accompanied by

a Certificate of Existence issued by the

official keeper of corporate records in the state or country of the corporation's formation.

The Certificate may not be more that 90 days old at the time of filing.

A renewed registration of corporate name expires at the end of the calendar year

during which an application is filed the next year.

Renewal may be filed between October 1

thru December 31

The renewal application when filed renews the registration for the following calendar year.

Please type or print all information other than the signature.

REV. 10/25/2007

Application To Renew A Registration Of Corporate Name Foreign Corporation - Connecticut Secretary Of State