District of Columbia Government Corporations Division Statement of Election to Accept for Domestic Non-Profit Corporation Under Old Act Form DNP-5. Version 2, July 2010. Pursuant to the provisions of the Non-Profit Corporation Act (D.C. Code, Title 29, Chapter 3 as amended), the undersigned corporation elects to avail itself thereto: 1. Name of the nonprofit corporation: 2. A resolution recommending that the corporation accept District of Columbia Non-profit Corporation Act was adopted in the following manner: (A) "The resolution was adopted at a meeting of members held on the following date, at which a quorum was present, and the resolution received at least two-thirds of the votes which members present or represented by proxy at such meetings were entitled to cast". (B) "The resolution was adopted by consent in writing signed by all members entitled to vote with respect thereto." (C) "The resolution was adopted at a meeting of the Board of Directors held on the following date and received the vote of a majority of the Directors in office, there being no members having voting rights in respect thereof." 3. Describe the corporation's specific purposes: 4. This corporation will have members: Yes No 4a. If corporation will have members, describe number of classes the members shall be divided into and the names of such classes. Mail all forms and required payment to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442-4400 Please check dcra.dc.gov to view organizations required to register, to search business names, to get step-by-step guidelines to register an organization, to search registered organizations, and to download forms and documents. Just click on "Corporate Registrations." American LegalNet, Inc. www.FormsWorkFlow.com 4b. If corporation will have members, describe whether the members will have voting rights or not. 5. The manner in which directors shall be elected or appointed: 6. The regulation of internal affairs of the corporation will be conducted in the following manner: 6a. The manner of the dissolution or final liquidation of the corporation in which remaining assets of the corporation shall be distributed: 7. Give the name and registered office address (not a PO Box) of the Registered Agent (RA) in the District. 8. The name and address of directors (At least 3 directors are required) and officers of the corporation. All Directors / Officers Physical Street Address If you sign this form, you agree that you understand that anyone who makes a false statement anywhere on it can be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC § 22-2405. President / Vice-President Signature Date Secretary / Assistant Secretary Date Signature Mail all forms and required payment to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442-4400 Please check dcra.dc.gov to view organizations required to register, to search business names, to get step-by-step guidelines to register an organization, to search registered organizations, and to download forms and documents. Just click on "Corporate Registrations." American LegalNet, Inc. www.FormsWorkFlow.com