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

Form 635_0104 - Application For Amended Certificate Of Authority - Nonprofit - 2001 Page 2

Name ________________________________________________________________________________

Address _______________________________________________________________________________

City, state, zip __________________________________________________________________________

Name ________________________________________________________________________________

Address _______________________________________________________________________________

City, state, zip __________________________________________________________________________

[Please attach additional pages as necessary]

8. The corporation amends or adds to the purposes it pursues in Iowa as follows:

_____________________________________________________________________________________

9. A certificate of existence, or a document of similar import, duly authenticated within 90 days prior to the date

of this application, by the official having custody of corporate records in the state or country of incorporation,

accompanies this application.

10. Signature __________________________________________________________________

Type or print name and title ____________________________________________________

NOTES:

1. The filing fee is $25.00. Make checks payable to SECRETARY OF STATE.

2. The document is to be signed by the chairperson of the board, the president, or other officer of the corporation.

If directors have not been selected, the document is to be signed by an incorporator. If the corporation is in the

hands of a court appointed fiduciary, the document is to be signed by the fiduciary. A copy of a signature is

acceptable for filing. Verification is not required.

3. One copy of the document is to be delivered to the Secretary of State for filing.

4. The effective time and date of the document is the later of the following:

a. the time of filing on the date it is filed;

b. the time specified in the document on the date it is filed;

c. the time and date specified in the document, not later than 90 days after the date it is filed.

SECRETARY OF STATE

Corporations Division

Lucas Building, 1st Floor

Des Moines, Iowa 50319

Phone: 515/281-5204

635_0104

rev 06/01

Form 635_0104 - Application For Amended Certificate Of Authority - Nonprofit - 2001 Page 2