Application For Reservation Of Name Nonprofit Corporation Form
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1APPLICATION FOR
Secretary of State Office
500 E Capitol Ave
RESERVATION OF NAME
Pierre, SD 57501
Clear Form
(605)773-4845
NONPROFIT CORPORATION
Please Type or Print Clearly in Ink
HELP
Original
Photocopy
Please submit one
and one
FILING FEE: $25
SECRETARY OF STATE
payable to
Telephone # ____________________
FAX #
_______________________
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, which period shall not be extended.
1. The name to be reserved is _______________________________________________________________________
______________________________________________________________________________________________
2. 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 a 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
application for a Certificate of Authority
Dated ____________________________
______________________________________________
(Signature of the applicant)
______________________________________________
(Printed Name)
______________________________________________
(Title)
______________________________________________
(Address)
______________________________________________
(City)
(State)
(ZIP+4)
reservationofnonprofitname April 2012
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