Certification Memo

Work) SUBMITTER’S INFORMATION DO NOT WRITE IN THIS SPACE Company/Firm or Individual’s Name Return Address City - State - Zip Attention: Phone Fax E-mail address Account Number CERTIFICATION REQUEST INFORMATION Name of Company/Entity File Number METHOD OF RETURN Messenger/Pick up Type of Certificate Requested Certified Copy of All Charter Documents Express Mail Acct Regular Mail Other Certified Copy of Charter Documents, Restated Forward Certified Copy Filed on Short Form Good Standing (check if additional language req.) Tax reports filed Taxes paid to date No taxes assessed Select Express Service Fax or E-mail is not available COMMENTS/FILING INSTRUCTIONS Long Form Good Standing (check if additional language req.) Tax reports filed Taxes paid to date No taxes assessed Certificate in RE: (Type of Cert.) Apostille - Country Other Check Total Enclosed CREDIT CARD INFORMATION Visa (Visa, MasterCard, American Express or Discover Card Only) INSTRUCTIONS CC --- 1..