Form 250 - Non-Profit Corporation Application For Certificate Of Authority - Rhode Island Secretary Of State - 1999 Page 2

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7. The names and respective addresses of its directors and officers are:
NAME
ADDRESS
Director
Director
Director
President
Vice President
Treasurer
Secretary
8. This application is accompanied by certified copies of its articles of incorporation and all amendments thereto, duly
authenticated by the secretary of state or other authorized officer of the jurisdiction of its incorporation.
Under penalty of perjury, we declare and affirm that we have examined
this Application for Certificate of Authority, including any accompanying
attachments, and that all statements contained herein are true and
correct.
Date:
Print Exact Name of Corporation Making Application
By _______________________________________________________
President or
Vice President
(check one)
AND
By _______________________________________________________
Secretary or
Assistant Secretary (check one)

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