Affidavit (Church Tax Exemption) {SS-4459}

For Office Use Only AFFIDAVIT Corporate Filings 312 Rosa L. Parks Ave. 6th Floor, William R. SnodgrassTower Nashville, TN 37243 THIS IS TO CERTIFY UNDER THE PENALTIES OF PERJURY THAT IS A CHURCH AND THE INTERNAL REVENUE SERVICE CONTINUES TO HONOR ITS CLAIM TO AN AUTOMATIC EXEMPTION FROM PAYMENT OF FEDERAL INCOME TAX UNDER ¶501(C)(3) OF THE INTERNAL REVENUE CODE (26 U.S.C., ¶501(C)(3)). I FURTHER CERTIFY THAT THE AFORESAID CORPORATION IS EXEMPT AND IS CURRENTLY OPERATING UNDER SAID EXEMPTION, AND I KNOW OF NO VIOLATIONS OF FEDERAL STATUTES AND RULES AND REGULATIONS OF FEDERAL DEPARTMENTS INCLUDING THE INTERNAL REVENUE SERVICE WHICH WOULD JEOPARDIZE THIS EXEMPTION. THIS AFFIDAVIT IS SUBMITTED IN LIEU OF PROVIDING THE NAMES AND ADDRESSES OF THE PRINCIPAL OFFICERS AND BOARD OF DIRECTORS OF THIS CORPORATION ON THE ANNUAL REPORT REQUIRED BY TENNESSEE CODE ANNOTATED SECTION 48-66-203. SIGNATURE OF PRESIDENT OR OTHER PRINCIPAL OFFICER OF THE CORPORATION STATE OF DATE COUNTY OF SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF , NOTARY PUBLIC DATE COMMISSION EXPIRES SS-4459 (Rev.11/99) RDA 1678 American LegalNet, Inc. www.FormsWorkFlow.com