Transmittal Information For All Business Filings Page 2

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APPLICATION FOR AUTHORITY
Tom Schedler
TO TRANSACT BUSINESS IN LOUISIANA
Secretary of State
(R.S. 12:304)
Foreign Corporation
Return to:
Commercial Division
Enclose $125.00 filing fee
P. O. Box 94125
Make remittance payable to
Baton Rouge, LA 70804-9125
Secretary of State
Phone (225) 925-4704
Do Not Send Cash
Web site:
Check one:
( ) Non Profit
Check one:
( )
Original Application
STATE OF
( ) Business
( )
Amended Application
PARISH/COUNTY OF
1. Corporation name:
2. Previous name:
3. Principal office address in state or country of incorporation:
4. Federal tax identification number:
5. Principal business office address:
PLEASE INCLUDE COMPLETE STREET ADDRESSES FOR THE FOLLOWING
6. Principal business establishment in Louisiana:
7. Registered office address in Louisiana:
8. Registered agent’s name and address in Louisiana:
9. Nature of business to be transacted in Louisiana:
10. Names and addresses of directors and officers:
Title and Date
To be signed by any officer
Sworn to and subscribed before me, the undersigned Notary Public, on this date:
Notary
AGENT’S ACCEPTANCE AND ACKNOWLEDGEMENT OF APPOINTMENT
I hereby acknowledge and accept the appointment of registered agent for and on behalf of the above named corporation.
Registered Agent
Sworn to and subscribed before me on this date:
Notary
SS326 Rev. 08/13

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