Corporate Reinstatement Form

CORPORATE REINSTATEMENT FORM

This Corporate Reinstatement Form is submitted by the undersigned to apply for reinstatement of corporate privileges for Corporation Name: , originally incorporated in State of Incorporation: , Entity/File Number: . The corporate status was administratively forfeited/dissolved on: .

Entity Type: Domestic Corporation Foreign Corporation

RECITALS

WHEREAS, the corporation named above failed to comply with statutory filing or fiscal obligations and its corporate privileges were administratively forfeited, suspended or dissolved by the filing authority effective on the date set forth above; and

WHEREAS, the corporation desires reinstatement of its corporate status and to restore all rights, privileges and powers lost by reason of such forfeiture, and represents that it has taken, or will take concurrently with this filing, all acts and remittances necessary to cure the grounds for forfeiture; and

WHEREAS, the undersigned is authorized by corporate resolution to apply for reinstatement, to certify to the accuracy of the statements contained herein, and to submit required fees, taxes, reports and supporting documentation.

NOW THEREFORE

In consideration of the foregoing recitals and the undertakings below, the undersigned hereby requests reinstatement and certifies as follows:

1. REINSTATEMENT REQUEST

The corporation requests reinstatement of its corporate existence and privileges as if the administrative forfeiture had not occurred, subject to the acceptance of this form and supporting documents by the filing authority. The undersigned agrees that reinstatement shall be effective as provided by applicable law and that the filing of this form is conditioned upon the payment and acceptance of all required fees, taxes, penalties and any statutory filings.

2. PAYMENT, TAXES AND FEES

The undersigned represents that all outstanding franchise taxes, fees, penalties and interest have been calculated and are paid or will be paid contemporaneously with this filing. Total amount remitted with this application: $.

Tax clearance or certificate of good standing is: Attached Pending — to be delivered upon issuance

3. CORPORATE COMPLIANCE CERTIFICATION

The undersigned certifies under penalty of perjury that, to the best of their knowledge, all reports required by statute have been filed, all required franchise taxes and other amounts due have been paid or arrangements for payment satisfactory to the appropriate agencies have been made, and the information contained in this form and in the accompanying attachments is true, complete and correct.

Last fiscal year for which report filed: . Tax account/reference number, if applicable: .

4. OFFICERS, REGISTERED AGENT AND PRINCIPAL OFFICE

5. ATTACHMENTS AND EXHIBITS

The undersigned submits the following attachments with this reinstatement form (check all that apply):

Articles of Reinstatement / Amendment Certificate of Good Standing / Tax Clearance Payment Receipts / Proof of Payment Corporate Resolution authorizing reinstatement

6. EFFECT OF REINSTATEMENT

Upon acceptance by the filing authority, reinstatement shall restore the corporation's existence, rights, privileges and powers as set forth by applicable law. Reinstatement shall not, however, retroactively extinguish liabilities or obligations incurred during the period of forfeiture, nor shall it affect rights vested in third parties except as expressly provided by statute.

7. NOTICES

8. GOVERNING LAW

This form and the process of reinstatement shall be governed by and construed in accordance with the laws of the jurisdiction of incorporation specified above. Any dispute arising from this application shall be resolved in the courts having jurisdiction in that jurisdiction.

9. ENTIRE AGREEMENT; SEVERABILITY; AMENDMENTS

This form, together with the attachments and any statutory filings accepted by the filing authority, constitutes the entire agreement between the filing parties regarding reinstatement. If any provision of this form is held invalid, the remaining provisions shall remain in full force and effect. This form may be amended only by written instrument executed by the undersigned and, where required, accepted by the filing authority.

10. AUTHORITY AND WARRANTY

The undersigned warrants that they are authorized to execute this form on behalf of the corporation, that corporate action authorizing this reinstatement has been duly taken and is in full force and that all statements and representations made herein are true and correct under penalty of perjury.

11. ADDITIONAL STATEMENTS

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