Non-Stock Application For Amended Certificate Of Authority (Foreign Nonprofit Corporation) - South Dakota Secretary Of State Page 2

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8. The purpose or purposes that the corporation is to engage in South Dakota.
9. The names and business addresses of its principal officers and directors. Please place a check mark next to the name
if 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
The application must be signed by an authorized officer of the corporation.
Dated ____________________________
______________________________________________
(Signature of an authorized officer)
______________________________________________
(Printed Name)
______________________________________________
(Title)
Nonstockamendedcertificateofauthority April 2012

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