Certificate Of Professional License {SFN 13610}

FOR OFFICE USE ONLY CERTIFICATE OF PROFESSIONAL LICENSE SECRETARY OF STATE SFN 13610 (03-2012) ID number: WO: Filed: By: No Fee Required TYPE OR PRINT LEGIBLY This certificate is provided in accordance with the requirements of N.D.C.C., Chapter 10-31 as supplement to the filing of Articles of Incorporation of a professional corporation, Articles of Organization of a professional limited liability company, the registration of a professional limited liability partnership, or the registration of a similar foreign organization. 1. Name of licensing board: 2. Profession: 3. Name of professional organization (corporation, limited liability company, limited liability partnership, or similar foreign organization) for which licensees are seeking certification: 4. Licensees: NAME ADDRESS 5. I, being authorized by the above named licensing board, hereby certify that the licensees listed in number 4 are legally authorized to render the professional service identified in number 2. Signature of Licensing Authority: Title: Date: State of ______________________________________________________ County of ____________________________________________________ Signed and acknowledged before me this ___________________________ (Notary Seal/Stamp) day of _________________________________,_____________________. _____________________________________________________________ Signature of Notary Public My commission expires: _________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com