Utah Division of Corporations & Commercial Code 
                                                                                     ANNUAL REPORT / RENEWAL FORM 
       Box 146705, Salt Lake City, Utah 84114-6705 
            Entity Number                             Entity Type                                        Renewal Fee    Expiration Date             LATE DATE & FEE

                                                                                                         Please see                                 Please see 
                                                                                                         schedule below                             below
                                                                                     
                                SUBMIT SEPARATE PAYMENTS & SEPARATE COUPONS FOR MULTIPLE RENEWALS 

  Entity Name: 
                   (Print name exactly as filed) 

                                                      PLEASE READ THE INSTRUCTIONS CAREFULLY 
                             INSTRUCTIONS FOR ANNUAL REPORT / RENEWAL FORM 
      ENTITY NUMBER:         This is the number issued to your business entity or trademark, either a 6 or 7 digit number followed by a hyphen and 
                             another 4 digit number. 
      ENTITY TYPE:           This is the type of entity that you are renewing 
      RENEWAL FEE:  
                   Domestic & Foreign Profit Corporations                            $20.00 Late Fee                  $10.00
                   Domestic & Foreign Non-Profit Corporations                        $10.00 Late Fee                  $10.00
                   Domestic & Foreign LLC                                            $20.00 Late Fee                  $10.00
                   Domestic & Foreign LP & LLLP                                      $20.00 Late Fee                  $10.00
                   DBA & General Partnership                                         $27.00       Late Fee            $  N/A 
                   Domestic & Foreign LLP                                            $27.00       Late Fee            $  N/A 
                   Business Trust                                                    $27.00 Late Fee                  $  N/A
                   Limited Cooperative Association                                   $  7.00      Late Fee            $  N/A 
                   Trademark                                                         $50.00 Late Fee                  $  N/A
      EXPIRATION DATE:       This is the date that the renewal is due (Anniversary date of the entity) 
      LATE DATE & FEE:       This is the date at which the renewal is overdue (see list above for applicable late fees) 
      ENTITY NAME:           This is the name of the entity that you are renewing 
      TIMELY RENEWAL:        Pursuant to Utah Law, all renewals must be filed within their legally prescribed time.  Failure to do so may result in the 
                             loss of all protection and privileges in the State of Utah 
      CHANGES:     The Registration Information Change Form is used to make changes to your filing. 
                             Download:     http://www.corporations.utah.gov 
                             Orders:       orders@utah.gov or (801) 530-4849, toll free in-state (877) 526-3994 
                   There is no fee involved with the Registration Information Change Form when it is filed in conjunction with the Annual 
                   Report / Renewal form during the entity’s renewal period.  However, if the Registration Information Change Form is filed 
                   at any other time during the year, the $15.00 non-refundable processing fee is still applicable. 
      OTHER:       Carefully detach Renewal Coupon and submit to the Division of Corporations with the appropriate fee.  For multiple 
                   renewals please submit separate payments.  Payments are accepted by check or money order and should be payable to 
                   “State of Utah.”  DO NOT SEND CASH.  Please indicate entity number and/or entity name on check. If you are faxing you 
                   must include a cover sheet with the number of a Visa, MasterCard or American Express and the date of expiration 
                   (Fax (801) 530-6438).  If you have questions concerning this renewal or would like to check the status of your record please 
                   contact the Corporations Information Center at: (801) 530-4849 or toll free in-state (877) 526-3994 or go to 
                   http://www.utah.gov/serv/bes.  Forms may be downloaded from our Web site:  http://www.corporations.utah.gov 

Under GRAMA {63G-2-201}, all registration information maintained by the Division is classified as public record.  For confidentiality purposes, the business 
entity physical address may be provided rather than the residential or private address of any individual affiliated with the entity. 

      06/18