Assumed Business Name - New Registration {01}

Assumed Business Name - New RegistrationSecretary of State - Corporation Division - 255 Capitol St. NE, Suite 151 - Salem, OR 97310-1327 - sos.oregon.gov/business - Phone: (503) 986-2200 In accordance with Oregon Revised Statute 192.410-192.490, the information on this application is public record.We must release this information to all parties upon request and it will be posted on our website.For office use only REGISTRY NUMBER:Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary.1. ASSUMED BUSINESS NAME: (To be registered) 2. DESCRIPTION OF BUSINESS: (Primary business activity)3. PRINCIPAL PLACE OF BUSINESS: (Street Address, City, State, Zip)4. WHO IS AUTHORIZED TO REPRESENT THE OWNERS:(Authorized Representative) (One name only) MAILING ADDRESS OF AUTHORIZED REPRESENTATIVE: NAMES OF OWNERS (REGISTRANTS) AND PUBLICLY AVAILABLE ADDRESSES: (List name and street address of each person or entity who will conduct or transact business under the assumed business name.) (Attach a separate sheet if necessary.) Name Street Address City State Zip 8.EXECUTION/SIGNATURE(S): (All owners/registrants must sign) I declare as an authorized signer, under penalty of perjury, that this document does not fraudulently conceal, obscure, alter, or otherwise misrepresent the identity of any person including officers, directors, employees, members, managers or agents.240 This filing has been examined by me and is, to the best of my knowledge and belief, true, correct and complete.240 Making false statements in this document is against the law and may be penalized by fines, imprisonment, or both. Signature: Printed Name: CONTACT NAME: (To resolve questions with this filing) PHONE NUMBER: (Include area code)FEESRequired Processing Fee $50 Assumed Business Name filings are good for 2 years Processing Fees are nonrefundable. Please make check payable to "Corporation Division".Free copies are available at sos.oregon.gov/business using the Business Name Search program. Assumed Business Name - New Registration (11/17) Registration or filing of a name does not grant exclusive rights or interests in that name. A name may be available for registration; however, someone else may hold a prior right to that name, or the name may be too similar to another, and may result in a case of legal action brought against the registrant for dilution or unfair competition of someone else's business.6.5. 7.COUNTIES: ALL COUNTIES (Statewide) Baker Benton Clackamas Clatsop Columbia Coos Crook Curry Deschutes Douglas Gilliam Grant Harney Hood River Jackson Jefferson Josephine Klamath Lake Lane Lincoln Linn Malheur Marion Morrow Multnomah Polk Sherman Tillamook Umatilla Union Wallowa Wasco Washington Wheeler Yamhill American LegalNet, Inc. www.FormsWorkFlow.com