State Of Delaware Qualification Certificate Of A Foreign Corporation Page 3

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STATE OF DELAWARE
QUALIFICATION CERTIFICATE
OF A FOREIGN CORPORATION
The foreign corporation hereby certifies as follows:
1.
The name of the foreign corporation is
2.
The foreign corporation is formed under the laws of
and is filing herewith a certificate evidencing its corporate
existence.
3.
The business which it proposes to do in the State of Delaware is as follows:
4.
The Registered Office of the foreign corporation in the State of Delaware is
located at
(street),
in the City of
, Zip Code
The name of the Registered Agent at such address upon whom process against this
foreign corporation may be served is
5.
The assets of said foreign corporation are $
and the
liabilities thereof are $
. The assets and liabilities indicated are as
of a date within six months prior to the filing date of this Certificate.
6.
The business which it proposes to do in the State of Delaware is the business it is
authorized to do in the jurisdiction of its incorporation.
By:
Authorized Officer
Name:
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