COVER LETTER 
                                                
TO: Registration Section 
    Division of Corporations 
 
SUBJECT:                                                                                   
     (Name of Alien Business Organization, Financial Institution, or Telehealth Provider) 
                                                
Dear Sir or Madam: 
 
The enclosed Designation of Registered Agent and Registered Office for Alien Business Organization, 
 Financial Institution, or Telehealth Provider and fee(s) are submitted for filing. 
 
Please return all correspondence concerning this matter to the following: 
 
                      (Name of Person) 
 
                      (Firm/Company)   
 
                           (Address) 
 
              (City/State and Zip Code) 
 
For further information concerning this matter, please call: 
 
                                         at (   )                                          
            (Name of Person)                      (Area Code & Daytime Telephone Number) 
 
    Mailing Address:                                         Street Address: 
    Registration Section                                     Registration Section 
    Division of Corporations                                 Division of Corporations 
    P.O. Box 6327                                            The Centre of Tallahassee 
    Tallahassee, FL 32314                                    2415 N. Monroe Street, Suite 810 
                                                             Tallahassee, FL 32303 
                        
Enclosed is a check for the following amount: 
 
 $35.00 Filing Fee                              $43.75 Filing Fee & Certified Copy          
                                                
INHS80 (4/20) 

 REGISTERED AGENT & OFFICE FOR ALIEN BUSINESS ORGANIZATION, 
     FINANCIAL INSTITUTION, OR TELEHEALTH PROVIDER 
 
PURSUANT  TO  SECTION  607.0505,  655.0201,  OR  456.47(4)(b),  FLORIDA  STATUTES,  THE 
UNDERSIGNED  ALIEN  BUSINESS  ORGANIZATION,  FINANCIAL  INSTITUTION  OR  TELEHEALTH 
PROVIDER SUBMITS THE FOLLOWING STATEMENT IN ORDER TO DESIGNATE ITS REGISTERED 
AGENT AND REGISTERED OFFICE IN THE STATE OF FLORIDA: 
 
1.                                                                                                                                  
                     (Name of alien business organization, financial institution or telehealth provider) 
                                                            
2.                                                            3.                                                                    
     (State or country under which entity is organized)                                               (FEI Number, if applicable) 
 
4.                                                                                                                                  
                                        (Principal office address) 
 
5. Name and Florida Street address of registered agent.  
                                                            
6. The street address of the registered office and the street address of the business office of the registered agent  
     are identical.  
 
7.                                                                                                                                  
                                     (Signature of chairman, vice chairman, or officer) 
                                                            
8.                                                                                                                                  
                       (Name and capacity of person signing in number 7 above) 
 
9.  Signature of registered agent:                                                                                                  
 
I hereby accept the appointment as registered agent.  I am familiar with and accept the obligations of section 
607.0505, 655.0201, or 456.47(4)(b) Florida Statutes. 
 
      (Registered agent accepting appointment)                                                                   (Date) 
 
THE  FILING  OF  THIS  FORM  WITH  THE  FLORIDA  DEPARTMENT  OF  STATE  DOES  NOT 
AUTHORIZE THE ABOVE REFERENCED ENTITY OR PROVIDER TO TRANSACT BUSINESS IN 
THE STATE OF FLORIDA. 
 
                                        FILING FEE $35 
                                                            
                      Make checks payable to Florida Department of State and mail to: 
                      Division of Corporations P. O. Box 6327 Tallahassee, FL  32314 
                                                            
INHS80 (4/20)