STATE OF LOUISIANA                                                             Commercial Division    
                                                                                                           (225) 925-4704  
                            SECRETARY OF STATE                                                               
   TOM SCHEDLER                                                                                            Fax Numbers 
SECRETARY OF STATE                                                                                         (225) 932-5317 Administrative Services 
                                                                                                           (225) 932-5314 Corporations 
                                                                                                           (225) 932-5318 UCC 
                                                                                                                                               
                            TRANSMITTAL INFORMATION
                            For All Business Filings

Business Name (List  exactly  as it appears in documents)

Name of person filing document (evidence of filing will be mailed to this person, at address below)

Address

City                         State                                                                 Zip Code

Daytime phone number        Fax number                                                             Email address

NOTE:  Louisiana Law requires all Louisiana notaries to print or type their name and notary or    
       bar roll number on the document.

                     Mailing Address:  P. O. Box 94125, Baton Rouge, LA * 70804-9125      
                     Office Location: 8585 Archives Ave.,  Baton Rouge, LA * 70809         
                            Web Site Address:   www.sos.la.gov

 SS984  Rev. 09/11

 Tom Schedler         CORPORATION/LIMITED LIABILITY COMPANY SUPPLEMENTAL
Secretary of State                                        INITIAL REPORT
                                                     (R.S. 12:25 & R.S. 12:1305)

                           Enclose $25.00 filing fee        Return to: Commercial Division
                        Make remittance payable to                     P. O. Box 94125
                   Secretary of State                                  Baton Rouge, LA 70804-9125
                   Do Not Send Cash                                    Phone (225) 925-4704
                                                                       Web Site: www.sos.la.gov

1.   The name of this company is: 
_____________________________________________________________

2.   The names and municipal addresses (not a P.O. Box only) of the first directors (corporation) or
       managers or members (limited liability company) are:

Name

Address

Name

Address

Name

Address

Name

Address

Corporations:      To be signed by incorporator(s) or shareholder(s):
LLC:               To be signed by each person who signed the Articles of Organization:

                                  Date
SS366 Rev. 09/11                                                                       (see instructions on back)

                   INSTRUCTIONS

                       Corporations

1. If a corporation’s first directors are not named in the Initial Report, a Supplemental 
   Report must be filed after they are selected.  The Supplemental  Report shall set forth 
   the name and address of each director, and shall be signed by each incorporator, or by
   any shareholder.

2. A copy of the Supplemental Report certified by the Secretary of State, shall be filed
   for record in the office of the recorder of mortgages of the parish in which the 
   registered office of the corporation is located.

                         Limited Liability Company

1. If a limited liability company’s initial managers or members are not named in the 
   Initial Report, a Supplemental Report must be filed after they are selected.  The 
   Supplemental Report shall set forth the name and address of each manager or 
   member.

2. The Supplemental Report shall be signed by each person who signed the Articles 
   of Organization.