Application For Reservation Of Name (Nonprofit Corp)

Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845 corpinfo@state.sd.us APPLICATION FOR RESERVATION OF NAME NONPROFIT CORPORATION SDCL 47-22-9, 10 Please Type or Print Clearly in Ink Please submit one Original and one Photocopy FILING FEE: $25 payable to SECRETARY OF STATE Telephone # ________________ Pursuant to the provisions of the South Dakota Law, the undersigned hereby applies for reservation of the following name for a period of one hundred twenty (120) days. The same applicant may not again reserve the same name until more than sixty days after the expiration date. 1. Name of Applicant: 2. The address of the principal office: Actual Street Address City State ZIP+4 Mailing Address in this State, if Different from Street Address City State ZIP+4 3. The name to be reserved is: 4. Check one to indicate how the reserved name is to be used: Incorporation of a domestic nonprofit corporation Domestic nonprofit corporation intending to change its name Foreign nonprofit corporation intending to make application for Certificate of Authority Foreign nonprofit corporation authorized in this state intending to change its name Any person intending to organize a foreign nonprofit corporation and to have such corporation make an application for a Certificate of Authority No person may execute this report knowing it is false in any material respect. Any violation may be subject to a criminal penalty (SDCL 22-39-36). Dated Signature of an authorized person Email (Optional) Printed Name Title Address City State Zip nonprofitnamereservation Sept 2016 American LegalNet, Inc. www.FormsWorkFlow.com