Arkansas Secretary of State Mark Martin State Capitol • Little Rock, Arkansas 72201 501-682-3409 • www.sos.arkansas.gov Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock APPLICATION FOR FOREIGN NONPROFIT CORPORATION SEEKING AUTHORIZATION TO DO BUSINESS IN ARKANSAS (PLEASE TYPE OR PRINT CLEARLY IN INK) Pursuant to Act 1147 of 1993, the undersigned Foreign Nonprofit Corporation submits the following: 1a. The name of the corporation is:____________________________________________________________ 1b. If the corporation is doing business in this state under another name, please state:___________________ ________________________________________________________________________________________ 2. The state, territory, or foreign country under whose laws the corporation was incorporated is:____________ ________________________________________________________________________________________ 3. The date of incorporation is:_______________________________________________________________ 4. The period of duration is: _________________________________________________________________ 5. The street address of its principal office or place of business is: ___________________________________ ________________________________________________________________________________________ 6. The name and street address of its registered agent for service of process in Arkansas is:_______________ ________________________________________________________________________________________ 7. The names and addresses of the corporation’s current directors are: 8. Check the box if the corporation has members. □ 9. Had this corporation been incorporated in Arkansas, check the appropriate box to indicate what type of corporation it would have been: (A.C.A. 4-32-1707) □ Public-Benefit Corporation □ Mutual-Benefit Corporation □Religious Corporation I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and /or imprisonment up to 30 days. Executed this ___________ day of _____________, __________________. _______________________________________________ ______________________________________________ Signature of Presiding Director or Officer Presiding Director or Officer (Type or Print) An original certificate of existence from the state of origin, dated in the past 30 days, must accompany the application. $300.00 Filing Fee payable to Arkansas Secretary of State NPF-1/Rev.03/12 American LegalNet, Inc. www.FormsWorkFlow.com Arkansas Secretary of State Mark Martin State Capitol • Little Rock, Arkansas 72201-1094 501-682-3409 • www.sos.arkansas.gov Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock Annual Report – Contact Information Nonprofit PLEASE TYPE OR PRINT CLEARLY IN INK JURISDICTION (SELECT ONE) □ DOMESTIC □FOREIGN In order for this entity to receive its annual reporting form, please complete and file with the Office of the Secretary of State at the time of filing. _____________________________________________________ __________________________________________________ Entity name as used in Arkansas Contact Person _____________________________________________________ __________________________________________________ Street Address or Post Office Box Number City, State Zip _____________________________________________________ __________________________________________________ Telephone Number E-mail Address NOTE: Annual Reports will be due on or before August 1st the year following filing or qualification in this state. I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days. Executed this ___________ day of _____________, __________________. _____________________________________________________ __________________________________________________ Signature Authorized Officer (Type or Print) NPF-1/Rev. 03/08 American LegalNet, Inc. www.FormsWorkFlow.com