Form 635-0105 - Application For Certificate Of Authority

Form 635-0105 - Application For Certificate Of Authority - Nonprofit

CHESTER J. CULVER

APPLICATION FOR

CERTIFICATE OF AUTHORITY

Secretary of State

(NONPROFIT)

State of Iowa

TO THE SECRETARY OF STATE OF THE STATE OF IOWA:

Pursuant to the Iowa Nonprofit Corporation Act, the undersigned corporation applies for a certificate of

authority to transact business in Iowa, and states:

1. The name of the corporation is _____________________________________________________________

1A. [See Note 5] The name the corporation will use in Iowa, if different than the legal name of the corporation is

_____________________________________________________________________________________

2. The corporation is incorporated under the laws of the state [or foreign country] of _______________________

3. The date of incorporation of the corporation was ________________________________________________

4. The duration of the corporation is ___________________________________________________________

5. The street address of its principal office is

Address _______________________________________________________________________________

City, State, Zip _________________________________________________________________________

6. The street address of its registered office in Iowa and the name of its registered agent at that office

Name ________________________________________________________________________________

Address _______________________________________________________________________________

City, State, Zip _________________________________________________________________________

7. The names and business addresses of its current directors and officers

Name ________________________________________________________________________________

Address _______________________________________________________________________________

City, State, Zip _________________________________________________________________________

Name ________________________________________________________________________________

Address _______________________________________________________________________________

City, State, Zip _________________________________________________________________________

635-0105

rev 06/01

Form 635-0105 - Application For Certificate Of Authority - Nonprofit