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Application For Registration Of Limited Cooperative Association Name Foreign Limited Cooperative Associations Only - Nebraska Secretary Of State

APPLICATION FOR REGISTRATION OF LIMITED

COOPERATIVE ASSOCIATION NAME

FOREIGN LIMITED COOPERATIVE ASSOCIATIONS ONLY

Submit in Duplicate

John A. Gale, Secretary of State

Room 1301 State Capitol, P.O. Box 94608

Lincoln, NE 68509

Attach a certificate of existence or authorization from the state or country of organization

executed by the official having custody of such records.

Name of Limited Cooperative Association ____________________________________

______________________________________________________________________

Organized under the laws of _____________________________________________

Date of Organization ____________________________________________________

Nature of affairs in which association is engaged ______________________________

_____________________________________________________________________

Registration is good for 120 days.

_________________________

DATED

______________________________

Signature of Officer or Authorized Representative

______________________________

Printed Name and Title

FILING FEE: For Profit $35.00 plus $5.00 per page for any additional pages

Not for Profit $35.00 plus $5.00 per page for any additional pages

1/1/2008

Neb. Rev. Stat. 21-2908

Application For Registration Of Limited Cooperative Association Name Foreign Limited Cooperative Associations Only - Nebraska Secretary Of State