Form Initial List-Profit1999.01 - Initial List Of Officers, Directors And Resident Agent - Nevada Secretary Of State

FILE NUMBER

INITIAL LIST OF OFFICERS, DIRECTORS AND RESIDENT AGENT OF

(PROFIT)

_____________________________________________________________________

___________________________

_____________________

(Name of Corporation)

(Incorporation Date)

A __________________________________________ CORPORATION

FOR THE FILING PERIOD _________________TO________________

(State of Incorporation)

The corporation’s duly appointed resident agent in the State of Nevada

Office Use Only

upon whom process can be served is:

Important: Read instructions before completing and returning this form.

1. Print or type names and addresses, either residence or business, for all officers and directors. A president, secretary, treasurer and at least one director must be named.

2. Have an officer sign the form.

FORM WILL BE RETURNED IF UNSIGNED.

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3. Return the completed form with the $85.00 filing fee. A $15.00 penalty must be added for failure to file this form by the 1

day of the 2

month following incorporation date.

4. Make your check payable to the Secretary of State. Your cancelled check will constitute a certificate to transact business per NRS 78.155. If you need a receipt, return page 2 certificate and ENCLOSE A SELF-

ADDRESSED STAMPED ENVELOPE. To receive a certified copy, enclose a copy of this completed form, an additional $10.00 and appropriate instructions.

5. Return the completed form to: Secretary of State, 101 North Carson Street, Suite 3, Carson City, NV 89701-4786, (775) 684-5708.

FILING FEE: $85.00

LATE PENALTY: $15.00

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THIS FORM MUST BE FILED BY THE 1

DAY OF THE 2

MONTH FOLLOWING INCORPORATION DATE

NAME

TITLE(S)

PRESIDENT

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

NAME

TITLE(S)

SECRETARY

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

NAME

TITLE(S)

TREASURER

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

NAME

TITLE(S)

DIRECTOR

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

NAME

TITLE(S)

DIRECTOR

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

NAME

TITLE(S)

DIRECTOR

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PO BOX

STREET ADDDRESS

CITY

ST

ZIP

I hereby certify this initial list.

X Signature of officer

Title(s)

Date

Nevada Secretary of State Form INITIAL LIST-PROFIT1999.01

Revised on: 01/11/00