APPLICATION TO REGISTER A <br /><br />BUSINESS TO BE CONDUCTED UNDER A TRADE NAME<br /><br />STATE OF GEORGIA<br /><br />COUNTY OF TIFT<br /><br />The undersigned hereby certifies that they are conducting a business at 706 North Parrish Avenue, in the city of Adel, County of Cook, state of Georgia under the name: COOK MEDICAL CENTER, A CAMPUS OF TIFT REGIONAL MEDICAL CENTER and that the type of business to be conducted is health care services and that said business is composed of the following persons: Tift County Hospital Authority, 901 E. 18th Street, Tifton, GA 31794. This affidavit is made in accordance with the Official Code of Georgia annotated, Title 10, Chapter 1, Section 490.<br /><br />William T. Richardson, Applicant<br /><br />Dennis L. Crum, Applicant<br /><br />Sworn to and subscribed before me this 18th day of June, 2012.<br /><br />Bonnie Roberson, Notary Public<br /><br />Lennis H. Storey, Deputy Clerk<br /><br />27.28<br /><br /> L. Chase Daughtrey<br /><br /> Judge, Probate Court<br /><br /> <br /><br /> Mrs. Gail White, Clerk of Court<br /><br /> Cook County Courthouse<br /><br /> 212 North Hutchinson Ave.<br /><br /> Adel, Georgia 31620<br /><br /> 229-896-3941