Annual Statement Publication - Mail-in Form ...
Statement to be published during:
    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 $40.00 to;

    3301 MALIBOU AVE
    PAHRUMP NV 89048-6489

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