Domestic Business Corporation Initial Report {341}

Tom Schedler Secretary of State DOMESTIC BUSINESS CORPORATION INITIAL REPORT (R.S. 12:25 AND 12:101) 1. The name of this corporation is: 2. The location and municipal address (not a P.O. Box only) of this corporation's registered office: 3. The full name and municipal address (not a P. O. Box only) of each of this corporation's registered agent(s) is/are: 4. The names and municipal address (not a P.O. Box only) of the first directors are: Incorporator(s) signature(s) AGENT'S AFFIDAVIT AND ACKNOWLEDGEMENT OF ACCEPTANCE I hereby acknowledge and accept the appointment of registered agent for and on behalf of the above named corporation. Registered agent(s) signature(s): Sworn to and subscribed before me, the undersigned Notary Public, on this date: NOTARY NAME MUST BE TYPED OR PRINTED WITH NOTARY # Notary Signature SS341 Rev. 09/11 (See instructions on back) American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS 1. An Initial Report must be completed and filed with the Articles of Incorporation of a Domestic Business Corporation. If no directors have been selected when the Initial Report and Articles of Incorporation are filed, a Supplemental Report, setting forth their names and addresses must be filed in accordance with R.S. 12:25. The Affidavit of Acknowledgement and Acceptance contained on the bottom of this form must be signed by each registered agent before a notary public. NOTE: Upon filing the Articles of Incorporation and Initial Report with our office, you will receive certified copies of both documents and a Certificate of Incorporation. Within thirty (30) days after filing with the Secretary of State's office, a copy of the Articles and the Initial Report certified by the Secretary of State and a copy of the Certificate of Incorporation must be filed with the office of the recorder of mortgages of the parish where the corporation's registered office is located. 2. 3. American LegalNet, Inc. www.FormsWorkFlow.com