Initial List Of Officers, Directors And Resident Agent

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(NONPROFIT) INITIAL LIST OF OFFICERS, DIRECTORS AND RESIDENT AGENT OF

FILE NUMBER

(Name of Corporation)

FOR THE FILING PERIOD OF

The corporation's duly appointed resident agent in the State of Nevada upon whom process can be served is:

A FORM TO CHANGE RESIDENT AGENT INFORMATION CAN BE FOUND ON OUR WEBSITE: secretaryofstate.biz

Important: Read instructions before completing and returning this form.

USE BLACK INK ONLY - DO NOT HIGHLIGHT

ABOVE SPACE IS FOR OFFICE USE ONLY

Return one file stamped copy. (If filing not accompanied by order instructions, file stamped copy will be sent to resident agent.)

1. Print or type names and addresses, either residence or business for all officers and directors. A President, Secretary, Treasurer, or equivalent of and all Directors must be named. There must be at least

one director. An officer must sign the form. FORM WILL BE RETURNED IF UNSIGNED

2. If there are additional directors attach a list of them to this form.

3. Return the completed form with the $25.00 filing fee. A $50.00 penalty must be added for failure to file this form by the last day of the first month following the incorporation/initial registration date.

4. Make your check payable to the Secretary of State. Your canceled check will constitute a certificate to transact business.

5. Ordering Copies: If requested above, one file stamped copy will be returned at no additional charge. To receive a certified copy, enclose an additional $30.00 per certification. A copy

fee of $2.00 per page is required for each additional copy generated when ordering 2 or more file stamped or certified copies,. Appropriate instructions must accompany your order.

6. Return the completed form to: Secretary of State, 202 North Carson Street, Carson City, NV 89701- 4201, (775) 684-5708.

7. Form must be in the possession of the Secretary of State on or before the last day of the first month following the initial registration date. (Postmark date is not accepted as receipt date.)

Forms received after due date will be returned for additional fees and penalties.

FILING FEE $25 00

LATE PENALTY $50 00

TITLE(S)

NAME

PRESIDENT

(OR EQUIVALENT OF)

ADDRESS

CITY

Zip

NAME

TITLE(S)

SECRETARY

(OR EQUIVALENT OF)

ADDRESS

CITY

Zip

TITLE(S)

NAME

TREASURER

(OR EQUIVALENT OF)

ADDRESS

CITY

Zip

TITLE(S)

NAME

DIRECTOR

ADDRESS

CITY

Zip

I declare, to the best of my knowledge under penalty of perjury, that the above mentioned entity has complied with the provisions of NRS 360.780 and acknowledge that pursuant to

NRS 239.330, it is a category C felony to knowingly offer any false or forged instrument for filing in the Office of the Secretary of State.

Title

Date

Signature of Officer

Nevada Secretary of State Form Initial List Nonprofit 2007

Revised on: 01/01/07

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