Legal Annual Report

LEGAL ANNUAL REPORT

This Legal Annual Report (the Report) is executed as of Date: by and between Company Name: (the Company) and Registered Agent Name: (the Registered Agent). The Company submits the following information for the reporting period ending: .

RECITALS

WHEREAS, the Company is an entity organized under the laws of its jurisdiction and is required by its governing instruments and applicable law to prepare and maintain an annual report setting forth specified corporate information and certifications;

WHEREAS, the Registered Agent has agreed to accept service and to receive notices on behalf of the Company and to assist in the delivery and filing of the annual report information as required by the Company; and

WHEREAS, the parties desire to attest to the accuracy of the information set forth in this Report and to provide the certifications and authorizations contained herein.

NOW THEREFORE, in consideration of the foregoing recitals and the mutual covenants set forth below, the parties agree as follows.

1. COMPANY IDENTIFICATION

1.1 Legal Name of Entity:

2. PRINCIPAL OFFICE

3. REGISTERED AGENT

3.1 Registered Agent Name:

3.2 Registered Agent hereby acknowledges acceptance of appointment and agrees to forward notices and service received on behalf of the Company in accordance with any governing agreements and applicable law: Registered Agent accepts appointment

4. DIRECTORS AND OFFICERS

Provide the names and business addresses of current directors and officers. Attach additional sheets if necessary.

5. CAPITAL STRUCTURE / MEMBERSHIP

5.1 Authorized Shares or Membership Units: Par Value (if applicable):

6. STATEMENT OF BUSINESS PURPOSE

7. FISCAL YEAR AND TAX CLASSIFICATION

Fiscal Year End (month/day): Tax Classification:

8. CERTIFICATION AND COMPLIANCE

The undersigned officers of the Company hereby certify, under penalty of law and to the best of their knowledge, that the information contained in this Report is true, correct, and complete as of the date set forth above and that they are duly authorized to execute this Report on behalf of the Company.

The Company further certifies that it has complied with all material filing, reporting, fee and tax requirements applicable for the reporting period and that no material actions have been taken that would require disclosure under governing instruments or law except as disclosed herein.

9. NOTICES

Notices under this Report shall be given in writing and shall be effective upon receipt at the respective notice addresses specified above or at such other address as a party may designate by written notice delivered in accordance with this section.

10. AMENDMENT; WAIVER; COUNTERPARTS

This Report may be amended or supplemented only by a written instrument executed by authorized representatives of both parties. No waiver of any provision of this Report shall be effective unless in writing and signed by the party waiving compliance. This Report may be executed in counterparts, each of which shall constitute an original and all of which together shall constitute one instrument.

GOVERNING LAW

This Report shall be governed by and construed in accordance with the substantive laws of the jurisdiction of the Company's formation, without regard to conflicts of laws principles that would result in the application of the laws of any other jurisdiction.

ENTIRE AGREEMENT

This Report, together with any attachments or schedules explicitly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements, understandings, negotiations and discussions, whether oral or written.

SEVERABILITY

If any provision of this Report is held to be invalid, illegal or unenforceable for any reason, the remaining provisions shall continue in full force and effect and shall be construed so as to effectuate the intent of the parties as closely as possible.

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