COVER LETTER 
  
 Department of State 
 Division of Corporations 
 P.O. Box 6327 
 Tallahassee, FL  32314 
  
 SUBJECT:                                                                                         
  
 Enclosed is an original and one (1) copy of the Certificate of Domestication and a check for: 
  
 FEES: 
  
    Certificate of Domestication                 $50.00 
    Articles of Incorporation and Certified Copy $78.75 
    Total to domesticate and file               $128.75 
                                      
 OPTIONAL: 
     
    Certificate of Status                        $ 8.75 
                              
                                  Name (printed or typed) 
                                      
                                     Address 
                                      
                                  City, State & Zip 
                                      
                              Daytime Telephone Number 
  
                            E-mail address: (to be used for future annual report notification) 
 
 INHS53b (12/12) 
                                      

                                        NOT FOR PROFIT 
                                 CERTIFICATE OF DOMESTICATION  
                                                       
The undersigned,__________________________________ , _______________________________ 
                                      (Name)                                                     (Title) 
of _____________________________________________________________a foreign Corporation 
                                 (Corporation Name) 
in accordance with section 617.1803, Florida Statutes, does hereby certify: 
 
1.  The date on which corporation was first formed was _________________________, ________ . 
 
2.  The jurisdiction where the above named corporation was first formed, incorporated, or otherwise 

       came into being was ____________________________________________________________ . 

3.  The name of the corporation immediately prior to the filing of this Certificate of Domestication  

      was __________________________________________________________________________ . 

4.  The name of the corporation, as set forth in its articles of incorporation, to be filed pursuant to 

    s. 617.01201 and 617.0202 with this certificate is _____________________________________ 

       _____________________________________________________________________________ . 

5.  The jurisdiction that constituted the seat, siege social, or principal place of business or central 
    administration of the corporation, or any other equivalent jurisdiction under applicable law, 
    immediately before the filing of the Certificate of Domestication was               
    _______________________________________________________________________________ 
 
6.  Attached are Florida articles of incorporation to complete the domestication requirements pursuant 
    to s. 617.1803. 
 
I am _________________ , of ________________________________________________________ 
 
and am authorized to sign this Certificate of Domestication on behalf of the corporation and have done 

so this the _____ day of _______________________________________________ , ___________ . 

                                _________________________________________________ 
                                          (Authorized Signature) 
                                                       
                                                Filing Fee: 
                                Certificate of Domestication                              $50.00 
                                Articles of Incorporation and Certified Copy              $78.75 
                                Total to domesticate and file                                      $128.75    

INHS53b (12/12) 

                         ARTICLES     OF INCORPORATION 
                 In compliance with Chapter 617, F.S. (Not for Profit) 
 
ARTICLE I       NAME 
The name of the corporation shall be: 
 
______________________________________________________________________________________ 
 
ARTICLE II      PRINCIPAL OFFICE 
The principal place of business/mailing address shall be: 
                   Principal Address                                                                  Mailing Address 
 
________________________________________             _______________________________________ 
 
________________________________________             _______________________________________ 
 
________________________________________             _______________________________________ 
 
________________________________________             _______________________________________ 
 
ARTICLE III      PURPOSE 
The purpose for which the corporation is organized: 
 
_____________________________________________________________________________________ 
 
_____________________________________________________________________________________ 
 
_____________________________________________________________________________________ 
 
_____________________________________________________________________________________ 
 
_____________________________________________________________________________________ 
 
_____________________________________________________________________________________ 
 
______________________________________________________________________________________ 
 
_____________________________________________________________________________________  
  
_____________________________________________________________________________________ 
 
_____________________________________________________________________________________ 
 
_____________________________________________________________________________________ 
 
_____________________________________________________________________________________ 
 
______________________________________________________________________________________ 
 

ARTICLE IV      MANNER OF ELECTION 
The manner in which the directors are elected or appointed: 
 
______________________________________________________________________________________ 
 
______________________________________________________________________________________ 
 
______________________________________________________________________________________ 
 
______________________________________________________________________________________ 
 
______________________________________________________________________________________ 
 
_____________________________________________________________________________________ 
 
ARTICLE  V    INITIAL DIRECTORS AND/ OR OFFICERS  
The name(s) and address(es) and specific title(s): 
 
Title/Name                                                                    Title/Name 
 
_________________________________________     _________________________________________ 
 
_________________________________________     _________________________________________ 
 
_________________________________________     _________________________________________ 
 
Title/Name                                                                     Title/Name 
 
_________________________________________   _________________________________________      
 
_________________________________________     _________________________________________ 
 
_________________________________________   _________________________________________      
 
Title/Name                                                                     Title/Name 
 
_________________________________________     _________________________________________ 
 
_________________________________________     _________________________________________ 
 
_________________________________________     _________________________________________ 
  

ARTICLE VI      INITIAL REGISTERED           AGENT AND STREET ADDRESS 
The name and Florida street address (P.O. Box NOT acceptable) of the registered agent is: 
 
_________________________________________ 
 
_________________________________________ 
 
_________________________________________ 
 
ARTICLE VII      INCORPORATOR 
The name and address of the incorporator is: 
 
_________________________________________ 
 
_________________________________________ 
 
_________________________________________ 
 
************************************************************************************** 
Having been named as registered agent and to accept service of process for the above stated corporation at the place designated 
in this certificate, I am familiar with and accept the appointment as registered agent and agree to act in this capacity. 
 
Signature/Registered Agent                                       Date 
 
Signature/Incorporator                                          Date