Declaration Regarding Lost Share Certificate

This Declaration Regarding Lost Share Certificate is for use by a shareholder who has lost a stock certificate. This declaration sets out the names of the corporation and shareholder, the number of the certificate and number of shares issued under the certificate. It also sets forth a declaration that the shares were not assigned or sold and that the certificate was mislaid, misplaced or inadvertently destroyed. A Declaration Regarding Lost Share Certificate will prove useful in the event the shareholder desires to either sell or vote the shares at a corporate meeting. This Declaration must be signed by the shareholder in the presence of a notary public. (continued ...)