CSCL/CD-314 (Rev. 10/17)
     Identification Number

                          PROFESSIONAL SERVICE CORPORATION
                                        LIST OF SHAREHOLDERS

SUBMIT ONE COPY WITH YOUR MICHIGAN ANNUAL REPORT FOR YEAR

NAME OF CORPORATION

Section 911(1)(f), Act 284, P.A. of 1972, as amended, requires that the annual report, Information Update, shall list the
names and addresses of all shareholders.
The corporation certifies that each shareholder is a licensed person in 1 or more of the professional services provided by the
professional corporation and that the corporation meets the other requirements of chapter 2A.
List names and complete addresses of all shareholders.  Include additional sheets if necessary.
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