CSCL/CD-274 (10/21 )

Michigan Department of Licensing and Regulatory Affairs                              FOR BUREAU USE ONLY
Corporations, Securities &Commercial Licensing Bureau     F              HC          Completed By                   Order Number 
Corporation sDivision 
Business Services Section - (517) 241-6470 

                             CERTIFICATION AND COPIES REQUEST
               (Authorized by P.A. 284 of 1972, P.A. 162 of 1982, P.A. 213 of 1982, P.A. 23 of 1993, as amended) 

       Identification Number                                             Entity Name
A.

B.

C.

D.

E.

  For orders submitted at the counter, add 25% surcharge. 

COPIES:                    CERTIFIED - minimum fee is $16.00; seven pages or more $1.00 additional per page.
                        U UNCERTIFIED - minimum fee is $6.00; seven pages or more $1.00 additional per page. 
                           Original Documents ONLY - NO Amendments
                            Original Documents and ALL Amendments
                            Annual Report(s)/Statement(s) Specify year(s)
                            Other:                                                             filed

CERTIFICATE(S):            Good Standing (Corporation and LLC) - $10.00                 Status (LLC) - $10.00
                           Not Cancelled (Limited Partnership) - $10.00          
                           Certificate of Fact - Listing ALL documents filed - $50.00   
                           Other Certificate of Fact - $20.00 - stating
                            Certificate of Fact - No Record - $20.00 

Return by:       Mail              Em ail

Billing Address:                                              Shipping Address:  (MAIL ONLY, if different than Billing)
Name                                                      Name

Attention                                                 Attention

Street Address                                            Street Address

Apt/Suite/Other                                           Apt/Suite/Other

City                        State          ZIP Code       City                                                State ZIP Code

Telephone Number            Email                         Telephone Number
(        )                                                (        )
                            **Orders totaling $100 or more require 50% deposit before order can be released.**