Legal Business Renewal Form

LEGAL BUSINESS RENEWAL FORM

This Legal Business Renewal Form is entered into on this day / / by and between Business Name: , Entity Type: Corporation Limited Liability Company Partnership , Registration Number: (the "Registrant"), and Authorized Representative Name: of Address: (the "Authorized Representative").

RECITALS

WHEREAS, the Registrant is duly organized and validly existing under the laws applicable to its entity type and holds a current registration identified by Registration Number: ; and

WHEREAS, the Registrant desires to renew its registration for an additional term, to confirm or update its principal information, and to certify compliance with statutory filing requirements; and

WHEREAS, the Authorized Representative is authorized to submit this Renewal Form on behalf of the Registrant and to certify the statements contained herein;

NOW, THEREFORE, in consideration of the mutual covenants and undertakings set forth in this Form, the parties hereby agree as follows:

1. RENEWAL APPLICATION

1.1 Renewal Request. The Registrant applies to renew its registration effective as of / / and certifies that the information provided in this Form is true and complete to the best of the Registrant's knowledge.

2. UPDATED ENTITY INFORMATION

3. FEES AND PAYMENT

3.1 Fee Acknowledgment. The Registrant acknowledges that a renewal fee is required. Fee amount submitted with this Form: $ . Payment is to be remitted in accordance with the applicable fee schedule and is nonrefundable except as required by applicable law.

4. REPRESENTATIONS AND WARRANTIES

4.1 Authority. The Authorized Representative represents and warrants that they are duly authorized by the Registrant to execute and deliver this Form and to take all actions necessary to effect the renewal.

4.2 Compliance. The Registrant represents and warrants that, as of the date of execution, it is in compliance with all filing obligations and has disclosed any material adverse changes in circumstances since the prior registration or last renewal.

5. CERTIFICATIONS

5.1 The Authorized Representative certifies under penalty of perjury that the information contained in this Renewal Form is true, correct and complete, and acknowledges that knowingly submitting false information may subject the Registrant and the Authorized Representative to civil or criminal penalties under applicable law.

6. NOTICES

6.1 All notices, requests, demands and other communications required or permitted under this Form shall be in writing and shall be delivered to the addresses set forth herein. Notice is effective upon receipt or, if sent by certified mail, three (3) days after deposit in the mail.

7. AMENDMENTS, WAIVER AND COUNTERPARTS

7.1 Amendments. This Form may be amended only by a written instrument executed by both parties.

7.2 Waiver. No failure or delay by either party in exercising any right shall operate as a waiver of that right, nor shall any single or partial exercise preclude any other or further exercise.

7.3 Counterparts. This Form may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument.

8. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

8.1 Governing Law. This Form shall be governed by and construed in accordance with the laws of the jurisdiction in which the Registrant is organized, without regard to conflicts of law principles.

8.2 Severability. If any provision of this Form is held invalid or unenforceable by a court of competent jurisdiction, the remaining provisions shall remain in full force and effect.

8.3 Entire Agreement. This Form constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether written or oral, relating to such subject matter.

9. SIGNATORY AUTHORITY

9.1 Each signatory below represents and warrants that they are authorized to execute this Renewal Form on behalf of the party for whom they sign and that execution of this Form is a binding obligation of that party.

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