Form Una-1 - Statement Of Agent Of Process For Unincorporated Non-Profit Association
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1Natalie E. Tennant
Penney Barker, Manager
Secretary of State
Corporations Division
1900 Kanawha Blvd E.
Tel: (304)558-8000
Bldg 1, Suite 157-K
Fax: (304)558-8381
Charleston, WV 25305
Hrs: 8:30 a.m. – 5:00 p.m. ET
STATEMENT OF AGENT OF
FILE ONE ORIGINAL
(Two if you want a filed
PROCESS FOR UNINCORPORATED
stamped copy returned to you)
NON-PROFIT ASSOCIATION
FEE: $15.00
1. The name of the Unincorporated Non-Profit
Association shall be:
________________________________________
2. The principal office address of the
__________________________________
Street:
association will be:
City/State/Zip: _______________________________________
located in the county of:
County:
_______________________________________
The mailing address of the association
Street/Box:
_______________________________________
if different, will be:
City/State/Zip: _______________________________________
3. The name and address of the person to
Name:
_______________________________________
whom notice of process may be sent,
in this state is:
Street:
_______________________________________
City/State/Zip: _______________________________________
4. Acknowledgement and Signatures:
________________________________________
Signature of appointed agent
________________________________________
This statement must be signed and
acknowledged by a person authorized
Signature of applicant
(authorized to act on behalf of company)
to manage the affairs of an unincorporated
________________________________________
non-profit association. The statement
must also be signed by the person appointed
Name of Contact person and phone number of person to
agent, who thereby accepts the appointment.
reach in case of problem with filing (optional)
________________________________________
Business e-mail address, if any
CHARITABLE REGISTRATION: If your company receives contributions, donations or grants,
registration as a charitable organization may be required. Contact our office for more information or
visit our website at .
Form UNA-1
Issued by the Office of the Secretary of State
Revised 10/09
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