Application To Renew A State Franchise {GAVFL005}

Secretary of State OFFICE OF SECRETARY OF STATE CORPOR A TIONS DIVISION 2 Martin Luther King Jr. Dr. SE Suite 313 West Tower Atlanta, Georgia 30334 (404) 656 - 2817 APPLICATION TO RENEW A STATE FRANCHISE Pursuant to O.C.G.A. 247 36 - 76 - 4, as amended, and the rules and regulations promulgated thereunder, the undersigned submits this application to renew a state franchise and does hereby certify the following: 1. Name of the state franchise certificate holder i s: 2. F ranchise number of the certificate holder s: 3. Date of issue of state franchise certificate : 4. If applicable, the address of principal place of business is updated as follows : Address: City: State: Zip Code: 5. If applicable, the mailing address of the certificate holder is updated as follows: Address: City: State: Zip Code : 6. If applicable , the names and respective addresses of the principal executive officers are updated as follows: (Attach additional page(s) if necessary.) NAME TITLE ADDRESS STATE ZIP CODE 7. The certificate holder certifies that a copy of this renewal application will provided to each affected municipal or county governing authority within seven (7) business days following delivery to the Secretary of State . 8. Signa t ure of Authorized Person Date Print Name Title Email Address Telephone Number Return this completed and notarized renewal application and a $ 50 .00 processing fee to the Secretary of State at the above address before the expiration date of the state franchise . There is no grace period. Renewal applications may be submitted up to 6 months prior to the expiration date. Renewal processing fees are non - refundable. GAVFL005 (Rev. 10/2018) American LegalNet, Inc. www.FormsWorkFlow.com