Annual Statement Publication - Mail-in Form ...

              Statement to be published during:    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;

      3301 MALIBOU AVE
      PAHRUMP NV 89048-6489

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