Form 635_0111a - Appointment Of Agent (501b)

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Appointment
MATT SCHULTZ
of Agent
Secretary of State
(501B)
State of Iowa
Pursuant to the provisions of the Revised Uniform Unincorporated Nonprofit Association Act, the
association submits the following statement to appoint an agent in Iowa.
1. The name of the association is: _________________________________________________
2. The address of the agent of the association is:
___________________________________________________________________________
Street
City
State
ZIP
3. The name of the agent is: ______________________________________________________
4. Signed, acknowledged and dated by:
Signature of authorized person: __________________________________________
Title: __________________________________
Date: _________________
Signature of appointed agent:____________________________________________
Date: ___________
The information you provide will be open for public inspection under Iowa Code section 22.11
INSTRUCTIONS
1. There is no filing fee.
2. One copy of the document is to be delivered to the Secretary of State for filing.
3. The required number of documents may be delivered by FAX.
SECRETARY OF STATE
Business Services Division
Lucas Building, 1st Floor
Des Moines, Iowa 50319
Phone: 515/281-5204 FAX: 515-281-7142 or 515/242-5953
Website:
635_0111A
rev 01/11

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