Domestic Professional Association Renewal

STATE OF ALABAMA DOMESTIC PROFESSIONAL ASSOCIATION ANNUAL RENEWAL NOTICE PAAnnual22611/2011Page1of2 PURPOSE: Under Section, 10A-30-1.10 of the Code of Alabama 1975 a Domestic Professional Association (PA) shall furnish a statement to the Secretary of State by the 30th day following November 1 of each year. A $25.00 filing fee (10A-1-4.31) must accompany the notice on a form designated by the Secretary of State. If the Renewal Notice is not filed timely, the PA is required to pay a $50.00 penalty fee in addition to the filing fee. INSTRUCTIONS: Mail two (2) signed originals of this completed Renewal Notice and the filing fee $25.00 (Section 10A-1-4.31) to the Secretary of State, LLP Annual Notice/ Business Services, P.O. Box 5616, Montgomery, Alabama, 36103-5616 no later than 30 (For SOS Office Use Only)days following November 1st of each year. If you are filing after the 30th day following November 1 in any year you must include a $50.00 penalty fee (total fee is $75.00 and you may make one check or money order). You may submit the filing via email to miscellaneous.filings@sos.alabama.gov if you are paying by credit card. FAX transmissions will not be accepted, acknowledged, or returned. If the credit card does not authorize or the check is dishonored your filing will be removed from the record. This form must be typed or laser printed. 1. Alabama Entity ID Number (Format: 000-000): - INSTRUCTION TO OBTAIN ID NUMBER TO COMPLETE FORM: You may obtain the entity ID number on our website at www.sos.alabama.gov under the Government Records tab. Click on Business Entity Records, click on Entity Name, enter the registered name of the Professional Association in the appropriate box, and enter. The six (6) digit number containing a dash to the left of the name is the entity ID number. If you click on that number, you can check the details page to make certain that you have the correct entity 226 this verification step is strongly recommended . 2. Name of the Professional Association as originally registered in the County Probate Office: 3. County Probate Office in which the Professional Association was registered: 4. Date on which the Professional Association was registered in the County Probate Office: / / MM/DD/YYYY 5. The principal address (no PO Boxes ) of the Professional Association is: 6. The mailing address, if different from the principal address, of the Professional Association is: American LegalNet, Inc. www.FormsWorkFlow.com DOMESTIC PROFESSIONAL ASSOCIATION ANNUAL NOTICEPAAnnual22611/2011Page2of2 7. The names and post office addresses of all members or shareholders in the Professional Association: NAME ADDRESS A listing of additional names and addresses is attached. 8. The undersigned President or Vice President of the Professional Association certifies that all members or shareholders are duly licensed or otherwise legally authorized to render professional services in this state as required under 10A-30-1.10. STATE OF ALABAMA COUNTY OF I, being duly sworn, do depose and state that I am (must be President or Vice President) of the Professional Association and make this affidavit and notice on its behalf. I read the above and foregoing Notice and know the contents thereof. The statements set out therein are true and correct at the time of my verification of the Notice. Signature Sworn to and subscribed before me this day of , 20 . Notary Public My Commission expires American LegalNet, Inc. www.FormsWorkFlow.com Secretary of State Credit Card Payment Option Sheet: If you provided a copy of your filing, you will receive a credit card receipt with that copy. If you did not send a copy to be returned to you, no receipt will be mailed. Office staff will not be able to research credit card payments to help you balance your accounts. Name of the Professional Association: Card Type: (Visa, MC, Discover & AmEx) Service Requested: $25.00 Renewal Notice filing fee $50.00 Penalty for filing after mandatory file date Card Number: Expiration Mo/Yr: / (MM/YY) Card Holder Name: Complete Billing Address: Street or PO City State Zip Signature of Card Holder: MUST be Signature of Card Holder PAAnnual22611/2011 American LegalNet, Inc. www.FormsWorkFlow.com