S-4: Registration of securities issued in business combination transactions
Published on August 10, 2010
CERTIFICATE OF TRUST
OF
[Company]
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FIRST:
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The undersigned, Omega Healthcare Investors, Inc., whose post-office address is 9690 Deereco Road, Suite 100, Timonium, Maryland 21093, does hereby form a business trust under the general laws of the State of Maryland.
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SECOND:
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The name of the Business trust is [Company] (the “Trust”).
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THIRD:
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The purpose for which the Trust is formed is as follows: To engage in any or all lawful business for which a business trust may be organized under the general laws of the State of Maryland.
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FOURTH:
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The street address of the principal office of the Trust in Maryland is c/o Omega Healthcare Investors, inc., 9690 Deereco Road, Suite 100, Timonium, Maryland 21093.
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FIFTH:
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The name of the resident agent of the Trust in Maryland is Omega Healthcare Investors, Inc., 9690 Deereco Road, Suite 100, Timonium, Maryland 21093.
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SIXTH:
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The number of trustees of the Trust shall be on (1), which number may be increased. The name of the initial trustee is: OHI Asset (PA), LLC, a Delaware limited liability company.
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IN WITNESS WHEREOF, I have signed this certificate and acknowledge the same to be my act.
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I hereby consent to my designation in this document as resident agent for this business trust
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SIGNATURE OF TRUSTEE:
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SIGNATURE OF RESIDENT AGENT LISTED IN FIFTH:
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/s/ Daniel J. Booth
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/s/ Daniel J. Booth
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Omega Healthcare Investors, Inc.
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Omega Healthcare Investors, Inc.
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Daniel J. Booth, Chief Operating Officer
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Daniel J. Booth & Chief Operating Officer
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RETURN TO:
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Mark E. Derwent
Myers Nelson Dillon & Shierk, PLLC
125 Ottawa Ave., N.W., Suite 270
Grand Rapids, Michigan 49503
Telephone: (616) 233-9640
Facsimile: (616) 233-9642
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CUST ID: _______________
WORK ORDER :________________
DATE: _______________
AMT. PAID:$191.00
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