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Sec. 180.0403, 181.0403 & 183.0104(3),Wis. Stats.

State of Wisconsin DEPARTMENT OF FINANCIAL INSTITUTIONS Division of Corporate & Consumer Services

NAME REGISTRATION APPLICATION - FOREIGN CORPORATION OR FOREIGN LIMITED LIABILITY COMPANY (ANNUAL)
1. Name of the foreign entity:

2. State or Country in which formed:

3. Date of formation:

4. This application is for an (indicate (X) one) ORIGINAL registration OR RENEWAL of a current registration, for the next calendar year. (NOTE: Renewal applications are accepted from October 1 ­ December 31.) 5. Street address of the foreign entity's principal office: City State Country Zip Code

6. The foreign entity is organized as a (indicate (X) one below) Business corporation, with capital stock Nonstock, not for profit corporation Limited liability company

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FILING FEE

$ 50.00 $ 25.00 $ 50.00

8. Attached is a current CERTIFICATE OF STATUS with respect to the foreign entity, issued by
the state or country under whose laws it is incorporated or organized.

DFI/CORP1-R(R12-06) Use of this form is voluntary.

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9. Executed on behalf of the foreign entity by: (Signature) (Date) Indicate (X) the title of the person signing - CORP - LLC (Printed Name) Pres. Member Secy. (Other Title) Manager

__________________________________________________________________________________ INSTRUCTIONS (Ref. ss. 180.0403, 181.0403 or 183.0104(3), Wis. Stats. for document content)
Submit one original and one exact copy along with the required filing fee and current CERTIFICATE OF STATUS to the address listed below. Make checks payable to the "Department of Financial Institutions". Filing fee is non-refundable. Sign the document manually or otherwise as allowed under sec. 180.0103(16), 181.0103(23) or 183.0107(1g)(c) Wis. Stats. Mailing Address: Department of Financial Institutions Phone: 608-261-7577 Physical Address for Express Mail: Department of Financial Institutions FAX: 608-267-6813 Division of Corporate & Consumer Division of Corporate & Consumer Services TTY: 608-266-8818 Services 345 W. Washington Ave ­ 3rd Fl. P O Box 7846 Madison WI 53707-7846 Madison WI 53703

NOTICE: This form may be used to accomplish a filing required or permitted by statute to be made with the department. Information requested may be used for secondary purposes. This document can be made available in alternate formats upon request to qualifying individuals with disabilities. 1, 2 & 3. Enter the name of the foreign corporation or foreign limited liability company, the state under whose laws it is organized and the date it was organized. 4. Indicate if the application is for an original annual registration or the renewal of a current registration for the next calendar year. 5. Provide the street address of the foreign corporation or foreign limited liability company's principal office. 6 & 7. Indicate whether the applicant is a foreign business corporation, foreign nonstock (including non-profit) corporation, or foreign limited liability company. (NOTE: There is no statutory provision for registering the name of a foreign limited partnership or foreign limited liability partnership.) FILING FEE - Remit the filing fee appropriate to the type of organization applying. Make check payable to Department of Financial Institutions. DFI/CORP1-R(R12-06) Use of this form is voluntary.
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NAME REGISTRATION APPLICATION FOREIGN CORPORATION OR LIMITED LIABILITY COMPANY NAME (ANNUAL)






Enter your return address within the bracket above.

Phone number during the day: ( INSTRUCTIONS (Continued)

) _______ - _________

8. Every application must be accompanied by a current CERTIFICATE OF STATUS (variously called "certificate of existence" or "certificate of good standing"), issued by the Secretary of State (or other official having custody of corporate records) under whose laws it is incorporated, attesting to the existence and status of the corporation. The certificate must be issued not more than 60 days prior to the delivery of this application. 9. The application is to be executed by an officer of the corporation or, if the applicant is a limited liability company, by a member or manager. Print or type the name and title of the person signing the application and enter the date the application was signed. ORIGINAL REGISTRATION Application for an original registration are accepted anytime during the calendar year, but all registrations expire December 31, unless terminated earlier. A registration is terminated at the time the foreign corporation or foreign limited liability company entity obtains a certificate of authority or registration to transact business in Wisconsin, or consents to use of the registered name by another entity. RENEWAL OF A CURRENT REGISTRATION A foreign corporation or foreign limited liability company whose name is currently registered under ss. 180.0403, 181.0403 or 183.0104(3), Wis. Stats., may renew that registration for the following calendar year by submitting a renewal application between October 1 and December 31. The application procedure and filing fee for a renewal is the same as for an original application, except that it is indicated (X) as a renewal.

DFI/CORP1-R(R12-06) Use of this form is voluntary.

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