Fill and Sign the Demand Inspection Form

Date Name: Office: Corporation: Address: Re: Demand for Inspection of the Corporate Books and Records of _________________, Inc. Dear: I, ______________________________(name), am the record holder of _____________ (number) shares of common stock of ____________________ (list stock), and hereby demand to inspect the books and records of the Corporation, its list of shareholders, and its stock ledger. This inspection is requested for a proper purpose, to wit: (list purpose for examining records and books) I further state that I have never offered for sale or sold any list of shareholders of this or any corporation, nor have I assisted any person in procuring the same. An inspection is requested at: Place: (where records maintained) Date: Time: ______________________ _____________ Shareholder ___________________________________ Print or Type Name STATE OF _____________________ COUNTY OF ____________________ In _______________ (City and State), on the _____________ day of ____________, 20___, before me, a Notary Public in and for the above state and county, personally appeared _____________________________________________, known to me or proved to be the person named in and who executed the foregoing instrument, and being first duly sworn, such person acknowledged that he or she executed said instrument for the purposes therein contained as his or her free and voluntary act and deed. Type of ID Produced: _________________________ Affiant is is not, personally known to me. ___________________________________ NOTARY PUBLIC ___________________________________ Print or Type Name My Commission Expires: ______________ (SEAL)