Annual Statement Publication - Mail-in Form ...



        Please enter all information in the appropriate boxes below.

        Note: Annual Statements must be published each calendar year.
        Please tell us the calendar year in which you would like your Statement published.
         
      Statement to be published during:
      (enter Publication Year)
         
      Company Name
         
      Company Officer Name
         
      One Title of Company Officer
         
      Company Principal Address
         
      Principal Address City State Zip
         
      NV Registered Agent Address
         
      Registered Agent City State Zip
         
      Upon publication a Certification of Publication
      will be sent to you by first class mail.

      Please tell us where to send the Certification.
         
      (The following information is not published.)
         
      Contact Name
         
      Contact Company Name
         
      Contact Address
         
      Contact City State Zip

      Send completed form along with your check in the amount of $80.00 to;

      NEVADA LEGAL PRESS
      3301 MALIBOU AVE
      PAHRUMP NV 89048-6489

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