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Form 3555l - Request For Tax Clearance Certificate Limited Liability Company Or Limited Liability Partnership - California Secretary Of State Page 4

CORPORATION, LIMITED LIABILITY COMPANY OR LIMITED LIABILITY

PARTNERSHIP ASSUMPTION OF TAX LIABILITY

The Assumption of Tax Liability

of (1) __________________________________________________________ )

)

A limited liability company or limited liability partnership

______________________________________________________________ ) ________________________

Secretary of State file number

)

by (2) _________________________________________________________ )

)

A corporation/limited liability company or limited liability partnership

______________________________________________________________ ) ________________________

Secretary of State file number, if applicable*

organized or qualified to do business within the State of California, unconditionally agrees to file

with the Franchise Tax Board all returns and data that is required and unconditionally agrees to pay

in full all tax liabilities, penalties, interest and fees of (1) __________________

_________________________________________________________________________________;

(2) _________________________________________

Exact corporation/limited liability company or

limited liability partnership name

_________________________________________

Signature and title of officer/manager/partner

State of _______________________________

County of _____________________________

On ________________________________________ before me, the undersigned, a Notary Public in and

for said State, personally appeared ___________________________________________________________

_______________________________________________________________________________________

personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s)

whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they

executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the

instrument the entity upon behalf of which the person(s) acted, executed the instrument.

WITNESS my hand and official seal.

Signature ________________________________________________________

Name __________________________________________________________

(typed or printed)

*LLC, LLP, and Corporation (qualified for less than one year) assumers must provide financial statement

FTB 3555L C1 (REV 11-1999) PAGE 4

Form 3555l - Request For Tax Clearance Certificate Limited Liability Company Or Limited Liability Partnership - California Secretary Of State Page 4