CSCL/CD-274 (10 7/1 )

Michigan Department of Licensing and Regulatory Affairs                                 FOR BUREAU USE ONLY
Corporations, Securities &Commercial Licensing Bureau          F          HC            Completed By                   Invoice 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:           Counter        Mail                  Email

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.**