Nonstock Application For Certificate Of Authority

Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845 corpinfo@state.sd.us 1.The Name of the corporation: The name of the state or other jurisdiction under whose laws it is incorporated:The date of incorporation:The period of duration of corporation:The address of its principal office (this is the address of the : Street Address City State ZIP+4 Mailing Address if different from street address City State ZIP+4 Email Address (Optional) 6.The South Dakota Registered Agent222s name: South Dakota law permits the registered agent to be either: A) a noncommercial registered agent (this may be anindividual), B) a commercial registered agent, or C) an office holder. Complete only one below, either (a) or (b) or (c). (a)The South Dakota Noncommercial Registered Agent222s name: Actual Street Address in this State City State ZIP+4 Mailing Address in this State, if Different from Street Address City State ZIP+4 Email Address (Optional) (b)When listing a Commercial Registered Agent, please state their CRA#. This number can be obtained from theCommercial Registered Agent. Commercial Registered Agent Name CRA# (c)Title of the office or other position with the business: Business Office222s Actual Street Address in this State City State ZIP+4 Mailing Address in this State, if Different from Street Address City State ZIP+4 Email Address (Optional) Page 1 of 2 NON-STOCK APPLICATION FOR CERTIFICATE OF AUTHORITYFOREIGN NONPROFIT CORPORATION SDCL 47-27-1 FILING FEE: $125 ayable to SECRETARY OF STATE American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Foreignnonprofitcertificateofauthority 7.The purpose(s) that the corporation is engaging in business in South Dakota: 8.The names and usual business addresses of its principal officers and directors. Place a check mark next to the nameif the principal officer serves as a director. President Street Address City State ZIP+4 Vice President Street Address City State ZIP+4 Secretary Street Address City State ZIP+4 Treasurer Street Address City State ZIP+4 Director Street Address City State ZIP+4 Director Street Address City State ZIP+4 Director Street Address City State ZIP+4 9.The foreign corporation shall deliver with the completed application an Original Certificate of Existence or a documentof similar import, duly authenticated by the Secretary of State or other official having custody of corporate records in thestate or other jurisdiction under whose law it is incorporated. No person may execute this report knowing it is false in any material respect. Any violation may be subject to a civil and/or criminal penalty (SDCL 22-39-36). Dated Signature of an authorized person Email (Optional) Printed Name Title American LegalNet, Inc. www.FormsWorkFlow.com