This form is designed to be filled out online for your
                                                                     convenience.  Enter the data and press print when
                                                                     ready.  Use the reset button to reset the entire form.

                                                                     Print           Reset
                                                           AFFIDAVIT 

                 OF FOREIGN PROFESSIONAL CORPORATION 

Comes now _____________________________________________ as __________________________________________________ 
                 (name)                                              (office held) 

of the __________________________________________________, a __________________________________________________ 
                 (corporate name)                                    (state) 

corporation and being duly sworn does upon his oath state: 

All the __________________________________________________________________________________shareholders, a 
                                  (Corporate Name) 

majority of the directors and all the officers, except for the possibility of the secretary and treasurer, are licensed in one or more states 

or territories of the United States or the District of Columbia to render a professional service described in the statement of purposes of 

the corporation. 

In Affirmation thereof, the facts stated above are true and correct: 
(The undersigned understands that false statements made in this filing are subject to the penalties provided under Section 575.040, RSMo) 

_______________________________________________________________________________________________________________ 
Signature PrintedName  Title Date 

                                                                     ___________________________________________________ 
                                                                     Name of Affiant 

                                                                                     Aff. (08/04)