CONSENT FOR USE OF ENTITY NAME State Form 56370 (R2 / 6-19)

Indiana Code 23-0.5-3-1 NO FILING FEE 1. Name of the entity granting use of its entity name

2. Date of formation or registration (month, day, year)

3. Name of the individual to whom the entity is granting consent (first name, last name)

4. Please select one of the following:

Check here if the entity is consenting to the use of its complete name, including its corporate ending. Example: If ABC, Inc. grants consent for another entity to use ABC, Inc.

Check here if the entity is consenting to the use of its name, excluding its corporate entity. Example: If ABC, Inc. grants consent for another entity to use ABC. However, the corporate ending must not be "Inc.," "Incorporated," etc.

I hereby verify, subject to penalties of perjury, that I have authority to grant the use of the entity name and that the statements contained herein are true, this ______ day of ________________________, 20______.

Signature

Printed name

Title