Form 48725 - Business Entity Report - Indiana Secretary Of State Page 3

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SECTION G

(Please list the name(s) and address(es) of current director(s). If necessary, attach an additional sheet.)

Name of Director

Street Address (number and street)

City

State

ZIP Code

SECTION H

(This must be signed by a corporate officer, chairman of the board, registered agent, certified public accountant or

an attorney employed by the entity or by a member or manager of the LLC.)

Required if registered agent information was updated:

By checking the box, the signator(s) represent(s) that the registered agent named in the application has consented to

the appointment of the registered agent.

In Witness Whereof, the undersigned executes this Indiana Business Report and verifies, subject to penalties of

perjury, that the statements contained herein are

true, this ______ day of ________________________, 20______.

Signature

Printed name

FEE SCHEDULE

FOR-PROFIT CORPORATIONS (Domestic and Foreign) AND LIMITED LIABILITY COMPANIES (Domestic and Foreign)

All above-named entities must file a biennial report with the Secretary of State. The fee is $50.00 for a two-year registration. The report is due in the

anniversary month of registration. Entities registered in an even year must file every even year. Entities registered in an odd year must file every odd year.

NONPROFIT CORPORATIONS (Domestic and Foreign)

All nonprofit corporations (domestic and foreign) must file a biennial report with the Secretary of State. The fee is $20.00 for a two-year registration.

Nonprofit corporations that were formed January 1 through June 30 will file their first biennial report, with the $20.00 filing fee, in 2017 and in each odd

year going forward. Nonprofit corporations that were formed July 1 through December 31 will file their first biennial report, with the $20.00 filing fee, in

2016. These entities will file their next biennial report in 2018 and in each even year going forward.

LIMITED LIABILITY PARTNERSHIPS AND LIMITED PARTNERSHIPS (Domestic and Foreign)

All limited liability partnerships and limited partnerships (domestic and foreign) must file a biennial report with the Secretary of State. The fee is $50.00 for

a two-year registration. Limited liability partnerships and limited partnerships that registered with the Secretary of State before January 1, 2018, will file

their first biennial report, with the $50.00 filing fee, by the end of their month of formation or registration in 2019 and in each odd year going forward.

Limited liability partnerships and limited partnerships that register on or after January 1, 2018, will file their biennial reports, with the $50.00 filing fee, by

the end of their month of registration every two years.

SERIES

Series do not file biennial reports.

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