Form 635_0104 - Application For Amended Certificate Of Authority - Nonprofit

APPLICATION FOR

CHESTER J. CULVER

AMENDED CERTIFICATE

Secretary of State

OF AUTHORITY

State of Iowa

(Nonprofit)

TO THE SECRETARY OF STATE OF THE STATE OF IOWA:

Pursuant to section 77 of the Iowa Nonprofit Corporation Act, the undersigned corporation applies to amend its

certificate of authority to transact business in Iowa, and states:

1. The name of the corporation is _____________________________________________________________

and the name the corporation uses in Iowa if different than its real name is:

_____________________________________________________________________________________

[If applicable] The name the corporation has been changed to is :

_____________________________________________________________________________________

2. The corporation is incorporated under the laws of the state [or foreign country] of _______________________

3. The date of incorporation of the corporation was ________________________________________________

4. The duration of the corporation is ____________________________________________________________

5. The street address of its principal office is

Address _______________________________________________________________________________