Llc Certificate Of Formation Page 3

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I, __________________________________, a forming member of the above listed Limited
Liability Company and do hereby state that I am an authorized person to sign the LLC Certificate
of Formation to be filed in the State of ______________________.
Dated this ___________________ day of ______________________, _________________.
______________________________________________________________________________
Signature of Authorized Agent
I, ________________________________, do hereby accept appointment as Registered Agent,
and state that I am familiar with the duties of Registered Agent of the above listed Limited
Liability Company.
Dated this ___________________ day of ______________________, _________________.
______________________________________________________________________________
Signature of Registered Agent
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