Form Sfn 16812a - Articles Of Incorporation For A North Dakota Or Farming Corporation Page 2

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FOR OFFICE USE ONLY
REGISTERED AGENT
ID #
CONSENT TO SERVE
SECRETARY OF STATE
File #
SFN 16812A (7974 + 16812) (5-00)
WO #
Filed
By
SEE REVERSE SIDE FOR FILING AND MAILING INSTRUCTIONS
1. FILING FEE: $10.00
TYPE OR PRINT LEGIBLY
2.
Name of the organization for which the registered agent is to serve (corporation, limited liability company, limited liability partnership, limited
partnership, limited liability limited partnership or real estate investment trust)
3. Name of the registered agent
4. Registered agent is (Check one)
5. Federal ID # or social security # of registered agent
An individual North Dakota resident
A corporation
A limited liability company
A limited liability partnership
6.
An individual appointed as registered agent must sign a consent to serve in that capacity. When a corporation, a limited liability company, or
limited liability partnership is named as registered agent, an officer or someone authorized by the organization may sign on behalf of the
corporation, limited liability company, or limited liability partnership.
"The undersigned, as the newly appointed registered agent, agrees to act as the registered agent for this organization until a change, or
resignation, is submitted to the Secretary of State under the provisions of North Dakota law."
Original signature of registered agent
Date

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