Annual Statement Publication - Mail-in Form ...

              Statement to be published during:     2022      2023
         
      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;

      NEVADA LEGAL PRESS
      3301 MALIBOU AVE
      PAHRUMP NV 89048-6489

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