ROSS MILLER Secretary of State 204 North Carson Street, Suite 1 Carson City, Nevada 89701-4520 (775) 684 5708 Website: www.nvsos.gov
Officer's Statement*
(PURSUANT TO NRS 80.030)
USE BLACK INK ONLY - DO NOT HIGHLIGHT ABOVE SPACE IS FOR OFFICE USE ONLY
Officer's Statement (Pursuant to NRS 80.030) 1. Name of corporation: (provide modified name also if filed pursuant to NRS 80.025)
name currently on file in Nevada
name in home state, if using modified name in Nevada
2. State of incorporation: 3. Changes reflected by filing of document: (check the appropriate spaces and/or describe under "other")
Name Stock Purpose Dissolution Merger Other: (specify changes)
4. Signature of officer making statement: (must be signed by an officer of the corporation)
X
Signature of Officer Title
* Submit this form with either a certified copy of or a certificate evidencing the filing of any document, amendatory or otherwise, relating to the original articles in the place of the corporations creation.
IMPORTANT: Failure to include any of the above information and submit with the proper fees may cause this filing to be rejected.
This form must be accompanied by appropriate fees.
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Nevada Secretary of State Officers Statement Revised: 3-12-09