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Form Cs1 - Supplement To The Unified Registration Statement Initial Registration Form Page 4

CS1

MINNESOTA SUPPLEMENT TO THE UNIFIED REGISTRATION STATEMENT

INITIAL REGISTRATION FORM

(Continued)

Section C: Board of Directors Signatures and Acknowledgment

The form must be executed pursuant to a resolution of the board of directors, trustees, or managing group and

must be signed by two officers of the organization. See Minn. Stat. § 309.52, subd. 3.

We, the undersigned, state and acknowledge that we are duly constituted officers of this organization,

being the ________________________(Title) and _________________________(Title) respectively, and that

we execute this document on behalf of the organization pursuant to the resolution of the

_____________________________(Board of Directors, Trustees, or Managing Group) adopted on the _____

day of ___________________, 20____, approving the contents of the document, and do hereby certify that the

________________________________(Board of Directors, Trustees or Managing Group) has assumed, and

will continue to assume, responsibility for determining matters of policy, and have supervised, and will continue

to supervise, the operations and finances of the organization. We further state that the information supplied is

true, correct and complete to the best of our knowledge.

_________________________________________

__________________________________________

Name (Print)

________________________________________

__________________________________________

Signature

________________________________________

__________________________________________

Title

________________________________________

__________________________________________

Date

Form Cs1 - Supplement To The Unified Registration Statement Initial Registration Form Page 4