Arkansas Secretary                      of State                                                 
                                                   1401 W.Capitol,  Suite 250,     Little Rock, AR 72201
                 John Thurston                           501-682-3409 • www.sos.arkansas.gov
                                    
                                   CORPORATE FRANCHISE TAX

In order for this corporation to receive its annual corporate franchise tax reporting form,
please complete and file with the office of the Secretary of State at the time of incorporation
or qualification.

                                   Corporate name

                                   Contact person

                                   Street address or Post Office Box number

                                   City, State, ZIP

Telephone number                                        E-mail address

                                   IRS link for obtaining a Federal Tax ID: https://www.irs.gov/businesses/small-
                                   businesses-self-employed/how-to-apply-for-an-ein
Federal Tax ID

I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State
is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.

Authorized Officer (Type or Print) Authorized Signature of Incorporator, Officer or Agent for the Corporation

                                                                                          FT-11 Rev. 12/20