LIST OF CORPORATION'S SHAREHOLDERS
I, [SECRETARY], of the Secretary of the above-named Corporation, certify that the list that is set out below is a list of all of the shareholders who own shares of the Corporation's outstanding shares of stock and are entitled to vote at the shareholders' meeting that the directors of the Corporation have called for the day of [DATE] because they were shareholders of record at the close of business on [DATE]. Shareholder Total Number of Shares Owned Total Number of Nonvoting Shares Owned
Dated: [DATE]
______________________ Secretary