Application For Business Trust (Domestic) {170}

Application for Business Trust - Domestic Secretary of State - Corporation Division - 255 Capitol St. NE, Suite 151 - Salem, OR 97310-1327 sos.or egon. gov/business - Phone: (503) 986-2200 REGISTR Y NUM BER: For office use only In accordance with Oregon Revised Statute 192.410-192.490, the information on this application is public record. W e must release this information to all parties upon request and it will be posted on our website. For office use only Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary. 1) NAME O F THE BUSINESS TRUST: 2) STATE OR COUN TRY O F FORM ATION: 3) NAME AND STREE T ADDRESS OF EACH TRUSTEE : 4) NAME OF OREGON REGISTERED AGENT: 5) REGISTERED AGENT'S PUBLICLY AV AILABLE ADDRESS: (Must be an Oregon Street Address, which is identical to the registered agen business office.) 6) ADDRESS WHERE THE DIVISION MAY MAIL NOTICES : 7) THE UNDERSIGNED ENCLOSES A COPY OF THE TRUST INSTRUMENT CRE ATING THE TRUST. 8) EXECUTION: (B y a Formation Agent.) 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. This filing has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. Making false statements in this document is against the law and may be penalized by fines, imprisonment, or both. Signature: Printed Name: Title: CONTACT NAME: (To resolve questions with this filing.) FEES Required Processing Fee $100 PHONE NUMBER: (Include area code.) 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. 170 - Application for Business Trust - Domestic (2/18) American LegalNet, Inc. www.FormsWorkFlow.com