Application For A Certificate Of Authority To Transact Business In Virginia {SCC759-921}

COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION SCC759/921 (08/13) APPLICATION FOR A CERTIFICATE OF AUTHORITY TO TRANSACT BUSINESS IN VIRGINIA AS A FOREIGN CORPORATION The name of the foreign corporation is (include, if required, any "for use in Virginia" name in parentheses) State or other jurisdiction of incorporation: Date of incorporation: Period of duration: (Mark if applicable:) The corporation was previously authorized or registered with the Commission to transact business in Virginia as a foreign business entity. (See Instructions.) Set forth additional information on an attachment. The post office address, including the street and number, of the corporation's principal office is . (number/street) (city or town) (state) (zip) The corporation's registered agent in VIRGINIA is The registered agent is (mark appropriate box): (1) an individual who is a resident of Virginia and an officer of the corporation. a director of the corporation. a member of the Virginia State Bar. . (2) a Virginia or foreign stock or nonstock corporation, limited liability company or registered limited liability partnership authorized to transact business in Virginia. OR The corporation's VIRGINIA registered office address, including the street and number, if any, which is identical to the business office of the registered agent, is ________________________________________________________________________, VA _______________, (number/street) (city or town) (zip) which is physically located in the county or city of OFFICERS: NAME AND TITLE BUSINESS ADDRESS . ____________________________________________ ____________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ DIRECTORS: NAME BUSINESS ADDRESS __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ ____________________________________________ ____________________________________________ STOCK: NUMBER OF SHARES AUTHORIZED TO BE ISSUED CLASS AND SERIES Signed in the name of the foreign corporation by: ________________________________________ (signature) __________________ (date) __________________________ (telephone number (optional)) ________________________________________ (printed name) _______________________________________________ (title) (see Instructions for requisite signature) Personal Information, such as a social security number, should NOT be included in a business entity document submitted to the Office of the Clerk for filing with the Commission. For more information, see Notice Regarding Personal Identifiable Information at www.scc.virginia.gov/clk. REVIEW THE INSTRUCTIONS THAT FOLLOW BEFORE SUBMITTING THIS FORM. American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS TO FORM SCC759/921 This application, which has been prescribed by the Commission, is required to be filed with the Commission by a foreign corporation in order to obtain a certificate of registration to transact business in Virginia. The application must be in the English language, typewritten or printed in black, legible and reproducible, and presented on uniformly white, opaque paper, free of visible watermarks and background logos. See §§ 13.1-604 and 13.1-804 of the Code of Virginia. This form can be downloaded from our website at www.scc.virginia.gov/clk/formfee.aspx Name: Set forth the name of the corporation exactly as it appears in its charter, as amended, without alteration or abbreviation. If the corporation is a stock corporation and its name does not contain the word corporation, incorporated, company or limited or the abbreviation Corp., Inc., Co. or Ltd. or, it must adopt a designated name for use in Virginia that adds one of the foregoing words or abbreviations to its name. The corporation's name must be distinguishable upon the records of the Commission. See §§ 13.1-762 and 13.1-924 of the Code of Virginia. To check the availability of a corporate name or a designated name, visit www.sccefile.scc.virginia.gov/NameAvailability or contact the Clerk's Office at (804) 371-9733 or toll-free in Virginia, 1-866-722-2551. If the corporation's name is not available, it must adopt a designated name for use in Virginia that is distinguishable upon the records of the Commission, with, if it is a stock corporation, a "corporate ending" identified above . On the application, after setting forth the corporation's true name, set forth the "for use in Virginia" name in parentheses. See §§ 13.1-762 and 13.1-924 of the Code of Virginia. Prior registration: If the corporation was previously authorized or registered to transact business in Virginia as a foreign corporation, limited liability company, business trust, limited partnership or registered limited liability partnership, with respect to e very such prior authorization or registration, set forth on an attachment the name of the entity, the entity's type, the state or other jurisdiction of incorporation, organization or formation; and the identification number that was issued to the entity by the Commission. Period of duration: Unless the corporation's charter provides for a limited corporate life, the period of duration is "perpetual." The principal office is the office where the principal executive offices of the corporation are located or, if there is no such office, the office, in or out of this Commonwealth, so designated by the board of directors. The address of the principal office must include a street address. See §§ 13.1-603 and 13.1-803 of the Code of Virginia. The corporation may not serve as its own registered agent. The address of the registered office must include a street and number if one is associated with the registered office's location, and the registered office address must be identical to the business office of the registered agent. See §§ 13.1-763 and 13.1-925 of the Code of Virginia. A rural route and box number may only be used if no street address is associated with the registered office's location. Set forth the name of the county or independent city in which the registered office is physically located. Counti es and independent cities in Virginia are separate local jurisdictions. Officers: Include the names, titles and complete business addresses of al