Form 635_0103 - Application For Amended Certificate Of Authority - Nonprofit Page 2
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2Name ________________________________________________________________________________
Address _______________________________________________________________________________
City, State, Zip _________________________________________________________________________
Name ________________________________________________________________________________
Address _______________________________________________________________________________
City, State, Zip _________________________________________________________________________
[Please attach additional pages as necessary]
9. A certificate of existence, or a document of similar import, duly authenticated within 90 days prior to the date
of this application, by the official having custody of corporate records in the state or country of incorporation,
accompanies this application.
10. Signature __________________________________________________________________
Type or print name and title ___________________________________________________
NOTES:
1. The filing fee is $25.00. Make checks payable to SECRETARY OF STATE.
2. The document is to be signed by the chairperson of the board, the president, or other officer of the corporation.
If directors have not been selected, the document is to be signed by an incorporator. If the corporation is in the
hands of a court appointed fiduciary, the document is to be signed by the fiduciary. A copy of a signature is
acceptable for filing. Verification is not required.
3. One copy of the document is to be delivered to the Secretary of State for filing.
4. The effective time and date of the document is the later of the following:
a. the time of filing on the date it is filed;
b. the time specified in the document on the date it is filed;
c. the time and date specified in the document, not later than 90 days after the date it is filed.
5. The information you provide will be open to public inspection under Iowa Code chapter 22.11.
SECRETARY OF STATE
Business Services Division
Lucas Building, 1st Floor
Des Moines, Iowa 50319
Phone: (515) 281-5204
FAX: (515) 242-5953 or (515) 281-7142
Website:
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