Application For Voluntary Association {VA-1}

FILE ONE ORIGINAL (Two if you want a filed stamped copy returned to you.)FILING FEE: $50 *Fee Waived for Veteran-owned associationControl # *** The undersigned, acting as organizer(s) according to the West Virginia Code 24747-9A-3 , submit the following *** registration for a West Virginia Voluntary Association, which shall be perpetual.1.The name of the Voluntary Association shall be:[The name may not contain any word or phrase which implies that it is organized for any purpose other than those contained in these articles of association, and may not contain a word indicating it is incorporated (WV Codes 47-9A-4, 31D-4-402, 31E-4-402 )]. 2.The address of the principal officeof the association will be: Located in the County of (required): Street: City: Street: State: Zip Code: The mailing address of the above location, if different, will be: Zip Code: State: City: 3.The name and address of the person(agent) to whom notice of legalprocess may be sent, if any, will be: Zip Code: State: City: Street: Name: *If the Association is formed under the laws of another State, list the State and Date of OriginalFormation. See also CHECK BOX below. Home State: Date of Original Formation: CHECK HERE to indicate you have obtained and submitted with this application a CERTIFICATE OF EXISTENCE (GOODSTANDING), dated during the current tax year, from your home state of original formation as required to process your application.The certificate may be obtained by contacting the Secretary of State's Office in the home state of original incorporation. 5.Website address of the business, if any (ex: yourdomainname.com): 4.E-mail address where business correspondence may be received: 6.Do you own or operate more than one business in West Virginia? b.Located in how many West Virginia counties? If "Yes"... a. How many businesses? Yes No Decline to answer* Answer a. and b. below. County:Form VA-1 Rev. 11/2017APPLICATION FOR VOLUNTARY ASSOCIATIONWest Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov b.Is the business a Scrap Metal Dealer? 9.The name(s) and address(es) of the organizer(s) of the association (You must list at least ONE organizer. Attach additional page if necessary.): NameAddress City State Zip Code a) b) 7.The association is organized as (check one):WEST VIRGINIA APPLICATION FOR VOLUNTARY ASSOCIATIONPage 2 8. a. The purpose for which this association is formed is as follows: (Describe the type(s) of business activity which will be conducted, for example, 223agricultural production of grain and poultry224, 223construction of residential and commercial buildings224, 223manufacturing of food products224, 223commercial painting.224 Purpose may conclude with words 223205including the transaction of any or all lawful business for which voluntary associations may be formed in West Virginia.224) Yes [If "Yes," you must complete the Scrap Metal Dealer Registration Form (Form SMD-1) and proceed to Section 9.] No [Proceed to Section 9.] NON-PROFIT, NON-STOCK FOR PROFIT Officer Title Officer Name No. & Street Address City State Zip Code 10.The Titles, Names and Addresses of the Officers (i.e., President, Vice-President, Secretary, Treasurer, etc.), Owners orMembers of the Voluntary Association who have authority to sign documents are [at least two (2) individuals must be listed;attach additional pages if necessary.] Check here acknowledging that the members of the association consent to recognition of the application by the laws of the State of West Virginia with respect to corporation to the voluntary association. Check here if you have attached a separate additional statement. 11.Attach any additional statement which may be required for the type of business to be conducted. Check here if the association will apply for a license to sell alcoholic beverages. The members agree to the following: The purpose of this restaurant and business establishment will be that of selling, servicing and disbursing alcoholic beverages, providing that a West Virginia Alcoholic Beverage Control Commission License is issued, and for the disbursing of food and foodstuffs from its kitchen facilities located on said premise and any and all other business activities pertinent to and being a common part of the general business of restaurants, bars, supper clubs and related businesses of this type. The aforesaid officers, hereinabove stated, mutually covenant and agree that they join themselves together for a common business purpose and, as such association members and officers, they fully intend to perform all the (....STATEMENT CONTINUED ON NEXT PAGE....) Page 3WEST VIRGINIA APPLICATION FOR VOLUNTARY ASSOCIATIONduties and functions of their particular offices, and that by their subsequent signatures to their Agreement of Association, they do pledge themselves to join in a common effort for the promotion and financial success of this said restaurant business. Said officers further mutually covenant and agree that they shall not knowingly violate any law of the State of West Virginia and or the United States of America and that they shall operate said restaurant business establishment at all times in a lawful manner and in a clean and decent atmosphere. Said officers further mutually covenant and agree that they shall make a proper accounting of said business and meet their obligations in as responsible a business manner as is available to them, and that no officer nor member of this association shall, in any way, cause his or her interest to be sold or disposed of unless first offering his or her interest to be sold to other members of this association as their right of first refusal to purchase the same. This Agreement of Association is made and entered into by all members hereto as a joint venture and shall be treated as such until otherwise indicated. The members of this association by their signatures to this agreement, mutually covenant and state that they have read the foregoing agreement and consent to all the terms and conditions herein contained. *Important Legal Notice Regarding Signature: Per West Virginia Code 24731D-1-129. Penalty for signing false document.Any person who signs a document he or she knows is false in any material respect and knows that the document is to be delivered to the secretary of state for filing is guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than one thousand dollars or confined in the county or regional jail not more than one year, or both. Important Note: This form is a public document. Please do NOT provide any personal identifiable information on this form such as social security number, bank account numbers, credit card numbers, tax identification or driver's license numbers. Date: c.Signature: b.Print name of person who is signing this application: Phone: a.Contact person to reach in case there is a problem with filing: 13.Contact and Signature Information* (See below Important Legal Notice Regarding Signature):12.Is the organization a "veteran-owned" organization?Per WV Code 59-1-2(j) effective July 1, 2015, the registration fee is waived for entities that meet the requirements as a "veteran-owned" organization. See attached instructions to determine if the organization qualifies for this waiver. In addition, a "veteran-owned" entity will have four (4) consecutive years of Annual Report fees waived AFTER the organization's initial formation [see WV Code 59-1-2a(m) ].National Personnel Records Center Military Personnel Records 1 Archives Drive St. Louis, MO 63138 Toll free: 1-86-NARA-NARA or 1-866-272-6272 Phone: 314-801-0800 www.archives.gov/veterans/military-service-recordsYou may obtain a copy of your Veterans Affairs Form DD214 by contacting: Yes (If "Yes," attach Form DD214) No CHECK BOX indicating you have attached Veteran Affairs Form DD214 Effective JULY 1, 2015, to meet the requirements for a 223veteran-owned224 organization, the entity filing the registration must meet the following criteria per West Virginia Code 24759-1-2a : 1.A 223veteran224 must be honorably discharged or under honorable conditions, and2.A 223veteran-owned busine