Name of Nonprofit Association:Federal tax Identification Number (if any):Address:Name and street address of person authorized as agent to receive service of process:I,,do hereby appoint the above-stated person as agentto receive service of process. I am authorized to manage the affairs of the nonprofit association.I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of Stateis a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.Authorizing Officer (Type or Print)Authorized SignatureDateI,, do hereby accept this appointment as agent toreceive service of process.I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of Stateis a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.SignatureDateFiling Fee: $25.00 payable to Arkansas Secretary of State Rev. Appointment of Agent to Receive Service of Process for Nonprofit Association(Please Type or Print) 001027021n024030n030007r013027r031n027035025016007031n031r007031n031r003n026020031025022"004020031031022r006025013021037001027021n024030n030*%%#$!$#,'002032030020024r030030036003025023023r027013020n022007r027033020013r030037%(#b020013031025027035002032020022f020024017037$'#$t 003n026020031025022037004020031031022r006025013021 American LegalNet, Inc. www.FormsWorkFlow.com