Secretary of State Control No.: 13468843 Date Filed:9/4/2014 8:21:35 PM STATE OF GEORGIA 2014 Corporation Annual Registration OFFICE OF THE SECRETARY OF STATE Annual Registration Filing Brian P. Kemp P.O. Box 23038 Secretary of State Columbus, Georgia 31902-3038 Information on record as of: 8:21:36 PM Entity Control No. 15752240 Amount Due: $55.00 Amount Due AFTER June 1, 2014: $55.00 Augusta Regional Collaboration Corporation 600 Broad St. Augusta, Georgia 30901 Each business entity registered or filed with the Office of Secretary of State is required to file an annual registration. Amount due for this entity is indicated above and below on the remittance form. Annual fee is $30. If amount is more than$30 , the total reflects amount(s) due from previous year(s) and any applicable late fee(s). Renew by April 1,2013 Your Annual Registration must be postmarked by June 1,2014. If your registration and payment are not postmarked by June 1,2014, you will be assessed a $25.00 late filing penalty fee. For faster processing, we invite you to file your Annual Registration online with a credit card at Http://sos.ga.gov/corporations/ The Corporations Division accepts Visa, MC, Discover, American Express and ATM/Debit Cards with the Visa or MC logo for online filings only. Annual Registrations not processed online require payment with a check, certified bank check or money order. We cannot accept cash for payment. You may mail your registration in by submitting the bottom portion of this remittance with a check or money order payable to Secretary of S t a t e . All checks must be preprinted with a complete address in order to be accepted by our offices for your filing. Absolutely, no counter or starter checks will be accepted. Failure to adhere to these guidelines will delay or possibly reject your filing. Checks that are dishonored by your bank are subject to a $30.00 NSF charge. Failure to honor your payment could result in a civil suit filed against you and/or your entity may be Administratively Dissolved by the Secretary of State. [See O.C.G.A. § 13-6-15 and Title 14, respectively.] Officer, address and Agent information currently of record is listed below. Please verify county of registered office. If correct and complete, detach bottom portion, sign, and return with payment. Or, enter changes as needed and submit. Complete each line, even if the same individual serves as Chief Executive Officer, Chief Financial Officer, and Secretary of the corporation. Note: Registered Agent address must be a street address in Georgia where the agent may be served personally. A mail drop or P.O. Box does not comply with Georgia law for registered office. P.O. Boxes may be used for principal office and officersaddresses. Any person authorized by the entity to do so may sign and file registration (including online filing). Additionally, a person who signs a document submits an electronic filing he or she knows is false in any material respect with the intent that the document be delivered to the Secretary of State for filing shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished to the highest degree permissible by law. [O.C.G.A. § 14-2-129.] Please return ONLY the original form below and applicable fee(s). For more information on Annual Registrations or to file online, visit Http://sos.ga.gov/corporations/ Or, call 404-656-2817. CORPORATION NAME ADDRESS CITY STATE ZIP THE ABOVE INFORMATION HAS BEEN UPDATED TO: CORPORATION NAME ADDRESS CITY STATE ZIP Augusta Regional Collaboration Corporation 600 Broad St. Augusta Georgia 30901 CEO: Matthew Kwatinetz 1516 E. Republican St, Apt 5 Seattle Washington 98112 CFO: Margaret Woodard 936 Broad Street, Suite 107 Augusta Georgia 30901 SEC: Rachael Grace Patten 213 W 35th St, Room 804 New York New York 10001 AGT: United States Corporation Agents, Inc. 1420 Southlake Plaza Dr. Morrow Georgia 30260 I CERTIFY THAT I AM AUTHORIZED TO SIGN THIS FORM AND THAT THE INFORMATION IS TRUE AND CORRECT. P.O. BOX NOT ACCEPTABLE FOR REGISTERED AGENTS ADDRESS COUNTY OF REGISTERED OFFICE: Clayton County AUTHORIZED SIGNATURE: Matthew Kwatinetz Date:9/4/2014 8:21:35 PM Total Due: Title:Incorporator Email: $55.00 BR201 2013 Corporation Annual Registration
Posted on: Fri, 19 Sep 2014 17:12:26 +0000
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